Provider Demographics
NPI:1710980438
Name:AITSEBAOMO, APEAMEOKHAI PHILIP (OD PHD)
Entity Type:Individual
Prefix:DR
First Name:APEAMEOKHAI
Middle Name:PHILIP
Last Name:AITSEBAOMO
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:PO BOX 25275
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77265
Mailing Address - Country:US
Mailing Address - Phone:713-721-9000
Mailing Address - Fax:713-721-9002
Practice Address - Street 1:12401 SOUTH POST OAK
Practice Address - Street 2:SUITE D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045
Practice Address - Country:US
Practice Address - Phone:713-721-9000
Practice Address - Fax:713-721-9002
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3114TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F1580Medicare PIN
80342EMedicare PIN
TXT92157Medicare UPIN