Provider Demographics
NPI:1396964490
Name:OYO BASSEY EYO
Entity type:Organization
Organization Name:OYO BASSEY EYO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OYO
Authorized Official - Middle Name:BASSEY
Authorized Official - Last Name:EYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-205-1000
Mailing Address - Street 1:4529 FOREST LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-6826
Mailing Address - Country:US
Mailing Address - Phone:972-205-1000
Mailing Address - Fax:
Practice Address - Street 1:4529 FOREST LN
Practice Address - Street 2:SUITE 102
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6826
Practice Address - Country:US
Practice Address - Phone:972-205-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0097030332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191580301Medicaid
TX191580302Medicaid
TX191580301Medicaid