Provider Demographics
NPI:1699936286
Name:ATUESTA, ENRIQUE (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:
Last Name:ATUESTA
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5739 BELLAIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5505
Mailing Address - Country:US
Mailing Address - Phone:713-668-1307
Mailing Address - Fax:713-668-0110
Practice Address - Street 1:5739 BELLAIRE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5505
Practice Address - Country:US
Practice Address - Phone:713-668-1307
Practice Address - Fax:713-668-0110
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR0773156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020137801Medicaid