Provider Demographics
NPI:1295401750
Name:ANTWI-BOASIAKO, KWAME (OD, PHD)
Entity Type:Individual
Prefix:
First Name:KWAME
Middle Name:
Last Name:ANTWI-BOASIAKO
Suffix:
Gender:M
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5622 LEICESTER
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6073
Mailing Address - Country:US
Mailing Address - Phone:281-624-9734
Mailing Address - Fax:
Practice Address - Street 1:4701 S PADRE ISLAND DR STE A
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4400
Practice Address - Country:US
Practice Address - Phone:361-730-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10380T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist