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General NPI Number Information
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NPI Number | 1407184740
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Entity Type | Organization
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Legal Business Name | MAXWELL A. OLUMBA, O.D., P.A.
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 08/21/2011
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Provider Practice Location Address
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Address Line | 5505 W OREM DR STE 400
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City | HOUSTON
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State | TX
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Zip | 77085-1276
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Country | US
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Telephone | 713-487-2020
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Fax | 713-487-2025
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Provider Business Mailing Address
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Address Line | 5505 W OREM DR SUITE #400
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City | HOUSTON
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State | TX
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Zip | 77085-1276
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Country | US
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Telephone | 713-487-2020
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Fax | 713-487-2025
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. MAXWELL A OLUMBA
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Credential | O.D.
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Telephone | 832-721-8697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 05955TG
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License Number State | TX
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