MEDICARE: DR. APEAMEOKHAI PHILIP AITSEBAOMO OD PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3114TG	TX

General Provider Information

NPI Number	:	1710980438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. APEAMEOKHAI PHILIP AITSEBAOMO OD PHD

Provider Business Mailing Address
First Line	:	PO BOX 25275
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77265
Country	:	US
Telephone Number	:	713-721-9000
Fax Number	:	713-721-9002

Provider Business Practice Location Address
First Line	:	12401 SOUTH POST OAK
Second Line	:	SUITE D
City	:	HOUSTON
State	:	TX
Zip	:	77045
Country	:	US
Telephone Number	:	713-721-9000
Fax Number	:	713-721-9002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	01/14/2008

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