Provider Demographics
NPI:1407184740
Name:MAXWELL A. OLUMBA, O.D., P.A.
Entity Type:Organization
Organization Name:MAXWELL A. OLUMBA, O.D., P.A.
Other - Org Name:CORINTHIAN POINTE TSO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLUMBA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:832-721-8697
Mailing Address - Street 1:5505 W OREM DR
Mailing Address - Street 2:SUITE #400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77085-1276
Mailing Address - Country:US
Mailing Address - Phone:713-487-2020
Mailing Address - Fax:713-487-2025
Practice Address - Street 1:5505 W OREM DR STE 400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77085-1276
Practice Address - Country:US
Practice Address - Phone:713-487-2020
Practice Address - Fax:713-487-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2011-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05955TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209046601Medicaid
0A5586Medicare PIN