Healthcare Provider Details

I. General information

NPI: 1245989748
Provider Name (Legal Business Name): OLUWAFEYIKEMI ORITSEETSOLAYE OKOME
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KEMI OKOME

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

111 E 210TH ST
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2020
  • Fax:
Mailing address:
  • Phone: 718-920-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number111077
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number111077
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: