=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699926261
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANET CHINYERE EKEZIE O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2008
-----------------------------------------------------
Last Update Date | 10/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12401 S POST OAK RD SUITE D
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77045-2020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-721-9000
-----------------------------------------------------
Fax | 713-721-9002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6111 METTLER LN
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77469-2243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-239-7055
-----------------------------------------------------
Fax | 713-778-1107
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 06526T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------