Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 6307T | TX |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 6307T | TX |
N | 152WP0200X | Pediatric Optomitrist | 6307T | TX |
NPI | 1316074545 |
---|---|
Provider Name | Dr. Lestavia Duplantier |
First Address | Houston, TX 77049-2524 |
Second Address | Houston, TX 77049-2524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 14/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00300Z | MEDICARE PTAN (01) | TX |
V06116 | (02) | TX |