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General NPI Number Information
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NPI Number | 1437263647
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Entity Type | Individual
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Provider Name | EVELYN OKAH AYIDU-OMO O.D
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Gender | Female
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4801 S COOPER ST
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City | ARLINGTON
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State | TX
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Zip | 76017-5928
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Country | US
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Telephone | 817-419-9999
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Fax | 817-375-1712
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Provider Business Mailing Address
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Address Line | 1005 MAZOURKA DR
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City | ARLINGTON
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State | TX
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Zip | 76001-6119
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Country | US
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Telephone | 817-419-9999
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Fax | 817-375-1712
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6385T
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License Number State | TX
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