Provider Demographics
NPI:1720517857
Name:OGUNDOLIE, DESIREE M
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:M
Last Name:OGUNDOLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14010 S POST OAK RD STE 1105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-5157
Mailing Address - Country:US
Mailing Address - Phone:832-774-5609
Mailing Address - Fax:346-980-7837
Practice Address - Street 1:14010 S POST OAK RD STE 1105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-5157
Practice Address - Country:US
Practice Address - Phone:832-774-5609
Practice Address - Fax:346-980-7837
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty