Healthcare Provider Details

I. General information

NPI: 1033373766
Provider Name (Legal Business Name): CKIKE R. MORDI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4899 GRIGGS RD SUITE A
HOUSTON TX
77021-2855
US

IV. Provider business mailing address

4899 GRIGGS RD SUITE A
HOUSTON TX
77021-2855
US

V. Phone/Fax

Practice location:
  • Phone: 713-748-5000
  • Fax: 713-995-0548
Mailing address:
  • Phone: 713-748-5000
  • Fax: 713-995-0548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7220T
License Number StateTX

VIII. Authorized Official

Name: CHIKE R MORDI
Title or Position: OWNER
Credential: O.D
Phone: 832-452-3596