MEDICARE: MAXWELL A. OLUMBA, O.D., P.A.

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	:	1407184740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXWELL A. OLUMBA, O.D., P.A.

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 STE 400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77085-1276
Country	:	US
Telephone Number	:	713-487-2020
Fax Number	:	713-487-2025

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. MAXWELL A OLUMBA
Credential	:	O.D.
Telephone Number	:	832-721-8697

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	08/21/2011

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