Provider Demographics
NPI:1750534236
Name:OKIKO
Entity type:Organization
Organization Name:OKIKO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ONWER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:AWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-415-1235
Mailing Address - Street 1:1000 NORA LN
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5466
Mailing Address - Country:US
Mailing Address - Phone:972-415-1235
Mailing Address - Fax:972-230-3715
Practice Address - Street 1:1000 NORA LN
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5466
Practice Address - Country:US
Practice Address - Phone:972-415-1235
Practice Address - Fax:972-230-3715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX653821331L00000X, 332BD1200X, 332BP3500X, 332H00000X, 3336H0001X, 335E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No331L00000XSuppliersBlood Bank
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332H00000XSuppliersEyewear Supplier
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier