Healthcare Provider Details

I. General information

NPI: 1720517857
Provider Name (Legal Business Name): DESIREE M OGUNDOLIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14010 S POST OAK RD STE 1105
HOUSTON TX
77045-5157
US

IV. Provider business mailing address

14010 S POST OAK RD STE 1105
HOUSTON TX
77045-5157
US

V. Phone/Fax

Practice location:
  • Phone: 832-774-5609
  • Fax: 346-980-7837
Mailing address:
  • Phone: 832-774-5609
  • Fax: 346-980-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: