Healthcare Provider Details

I. General information

NPI: 1750534236
Provider Name (Legal Business Name): OKIKO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NORA LN
DESOTO TX
75115-5466
US

IV. Provider business mailing address

1000 NORA LN
DESOTO TX
75115-5466
US

V. Phone/Fax

Practice location:
  • Phone: 972-415-1235
  • Fax: 972-230-3715
Mailing address:
  • Phone: 972-415-1235
  • Fax: 972-230-3715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code331L00000X
TaxonomyBlood Bank
License Number653821
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number653821
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number653821
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number653821
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number653821
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number653821
License Number StateTX
# 7
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number653821
License Number StateTX

VIII. Authorized Official

Name: ELIZABETH AWA
Title or Position: PRESIDENT/ONWER
Credential:
Phone: 972-415-1235