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1417975368 NPI number — IKAEHOTA AIGBIVBALU NYOWHEOMA O.D

NPI Number: 1417975368
Health Care Provider/Practitioner: IKAEHOTA AIGBIVBALU NYOWHEOMA O.D

Information about “1417975368” NPI (IKAEHOTA AIGBIVBALU NYOWHEOMA O.D) exists in 1417975368 in HTML format HTML  |  1417975368 in plain Text format TXT  |  1417975368 in PDF (Portable Document Format) PDF  |  1417975368 in an XML format XML  formats.

NPI Number : 1417975368 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417975368",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NYOWHEOMA",
    "FirstName": "IKAEHOTA",
    "MiddleName": "AIGBIVBALU",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "O.D",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 300997",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HOUSTON",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77230-0997",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "713-647-0864",
    "MailingAddressFaxNumber": "713-647-0867",
    "FirstLinePracticeLocationAddress": "300 MEMORIAL CITY WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOUSTON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77024-2599",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "713-647-0864",
    "PracticeLocationAddressFaxNumber": "713-772-4004",
    "EnumerationDate": "07/18/2006",
    "LastUpdateDate": "06/21/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "152W00000X",
        "TaxonomyName": "Optometrist",
        "LicenseNumber": "05059",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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