MEDICARE: DR. MAXWELL ANOZIE OLUMBA O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	05955TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194709741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAXWELL ANOZIE OLUMBA O.D.

Provider Business Mailing Address
First Line	:	5505 W OREM DR
Second Line	:	SUITE 400
City	:	HOUSTON
State	:	TX
Zip	:	77085-1276
Country	:	US
Telephone Number	:	713-487-2020
Fax Number	:	713-487-2025

Provider Business Practice Location Address
First Line	:	5505 W OREM DR
Second Line	:	SUITE 400
City	:	HOUSTON
State	:	TX
Zip	:	77085-1276
Country	:	US
Telephone Number	:	713-487-2020
Fax Number	:	713-487-2025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	08/22/2011

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