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General NPI Number Information
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NPI Number | 1457563322
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Entity Type | Individual
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Provider Name | OSAZUWA JOHN OKUNDAYE O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 05/24/2019
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Provider Practice Location Address
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Address Line | 870 E ALTON GLOOR BLVD STE A
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City | BROWNSVILLE
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State | TX
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Zip | 78526-3364
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Country | US
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Telephone | 956-574-9002
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Fax | 956-575-0392
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Provider Business Mailing Address
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Address Line | 870 E ALTON GLOOR BLVD STE A
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City | BROWNSVILLE
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State | TX
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Zip | 78526-3364
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Country | US
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Telephone | 956-574-9002
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Fax | 956-574-0392
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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 | 3828TG
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License Number State | TX
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