Provider Demographics
NPI:1316074545
Name:DUPLANTIER, LESTAVIA (OD)
Entity type:Individual
Prefix:DR
First Name:LESTAVIA
Middle Name:
Last Name:DUPLANTIER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 E SAM HOUSTON PKWY N STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-2524
Mailing Address - Country:US
Mailing Address - Phone:281-459-3700
Mailing Address - Fax:281-459-9700
Practice Address - Street 1:5815 E SAM HOUSTON PKWY N STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-2524
Practice Address - Country:US
Practice Address - Phone:281-459-3700
Practice Address - Fax:281-459-9700
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6307T152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00300ZOtherMEDICARE PTAN
TX8FO836Medicare ID - Type Unspecified
TX00300ZOtherMEDICARE PTAN