MEDICARE: EYE MD OF TEXAS

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
2	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1437659505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE MD OF TEXAS

Provider Business Mailing Address
First Line	:	2424 HAMILTON ST STE 210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-1203
Country	:	US
Telephone Number	:	346-616-5035
Fax Number	:	346-616-5152

Provider Business Practice Location Address
First Line	:	2424 HAMILTON ST STE 210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-1203
Country	:	US
Telephone Number	:	346-616-5035
Fax Number	:	346-616-5152

Authorized Official
Title or Position	:	OWNER
Name	:	EMELIKE AGOMO
Credential	:	MD
Telephone Number	:	346-616-5035

Provider Enumeration Date	:	02/15/2018
Last Update Date	:	07/14/2020

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Directions to “EYE MD OF TEXAS ” Practice Location

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