Active NPI
Lourdes Maria Costa, OD
- Optometrist
- Houston, TX
National Provider Identifier
1477634814
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 5202T
- Practice address
- 4412 North Fwy
Houston, TX 77022-3606 - Phone
- (713) 884-8114
- Fax
- (713) 699-0191
- NPI assigned
- Oct 18, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 5202T | TX | Primary |
Addresses
Primary practice location
4412 North Fwy
Houston, TX 77022-3606
Mailing address
PO Box 920593
Houston, TX 77292-0593
Phone (713) 884-8114
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 917354 | Other | TX | BLOCK VISION |
| PO81175E5 | Medicaid | TX | |
| 919239 | Other | TX | EYEMED |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110114000500 | TX | Practitioner - Optometry | 3072702588 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5202T | TX | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440201600000",
"number": "1477634814",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 920593",
"city": "HOUSTON",
"state": "TX",
"postal_code": "772920593",
"telephone_number": "713-884-8114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4412 NORTH FWY",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770223606",
"telephone_number": "713-884-8114",
"fax_number": "713-699-0191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTA",
"first_name": "LOURDES",
"middle_name": "MARIA",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-18",
"last_updated": "2015-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "5202T",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLOCK VISION",
"identifier": "917354",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PO81175E5",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EYEMED",
"identifier": "919239",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
- Anisleidy Costa Manzano, FNP-C
- Costa Surgical, PA
- Lynz Ann Costa-Adams, LCSW
- Amber Quarles Costa, M.S. CCC/SLP
- Bruno Almeida Costa, MD
- Anthony Costales, M.D.
- John Samuel Costanza, MD
- Costco Wholesale Corporation (Costco Pharmacy #1018)
- Costco Wholesale Corporation (Costco Hearing Aid #675)
- Costco Wholesale Corporation (Costco Optical #680)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.