Provider Demographics
NPI:1437263647
Name:AYIDU-OMO, EVELYN OKAH (OD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:OKAH
Last Name:AYIDU-OMO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1005 MAZOURKA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-6119
Mailing Address - Country:US
Mailing Address - Phone:817-419-9999
Mailing Address - Fax:817-375-1712
Practice Address - Street 1:4801 S COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5928
Practice Address - Country:US
Practice Address - Phone:817-419-9999
Practice Address - Fax:817-375-1712
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6385T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX921667OtherTRUVISION(BLOCK)
TX341979359OtherSAFEGUARD
TX0008FFOtherBLUE CROSS BLUE SHIELD
TX743019386OtherNVA/ALWAYS VISION
TX341979359OtherSPECTERA
TX49187OtherDAVIS VISION