Healthcare Provider Details

I. General information

NPI: 1144484858
Provider Name (Legal Business Name): CHIKE R MORDI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4899 GRIGGS RD
HOUSTON TX
77021-2855
US

IV. Provider business mailing address

4899 GRIGGS RD
HOUSTON TX
77021-2855
US

V. Phone/Fax

Practice location:
  • Phone: 713-748-5000
  • Fax: 713-748-5000
Mailing address:
  • Phone: 713-748-5000
  • Fax: 713-748-8707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number7220TG
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number7220TG
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number7220TG
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7220TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: