Individual provider Active NPI

Deborah Ellen Fontenette, O.D.

  • Optometrist
  • Houston, TX
National Provider Identifier
1508977372
Registry record updated Oct 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
02604 Issued in TX
Practice address
906 Wayside Dr
Houston, TX 77011-2518
Phone
(713) 678-8288
Fax
(713) 678-4013
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 02604 TX Primary

Addresses

Primary practice location

906 Wayside Dr
Houston, TX 77011-2518

Mailing address

906 Wayside Dr
Houston, TX 77011
Phone (713) 921-6262

Other identifiers 1

IdentifierTypeStateIssuer
112306061MedicaidTX

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260326001629 TX Practitioner - Optometry 2769590439 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 1983
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

12926 Crystal Cove Dr
Houston, TX 77044-1802

1435 Pennygent LN
Channelview, TX 77530-2289

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
02604TXMDOptometrist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540339200000",
    "number": "1508977372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 WAYSIDE DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77011",
            "telephone_number": "713-921-6262",
            "fax_number": "713-674-9314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 WAYSIDE DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770112518",
            "telephone_number": "713-678-8288",
            "fax_number": "713-678-4013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTENETTE",
        "first_name": "DEBORAH",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2018-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "02604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112306061",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.