Individual provider Active NPI

Ikaehota Aigbivbalu Nyowheoma, O.D

  • Optometrist
  • Houston, TX
National Provider Identifier
1417975368
Registry record updated Jun 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
05059 Issued in TX
Practice address
300 Memorial City Way
Houston, TX 77024-2599
Phone
(713) 647-0864
Fax
(713) 772-4004
NPI assigned
Jul 18, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 21, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 05059 TX Primary

Addresses

Primary practice location

300 Memorial City Way
Houston, TX 77024-2599

Mailing address

PO Box 300997
Houston, TX 77230-0997
Phone (713) 647-0864

Other identifiers 2

IdentifierTypeStateIssuer
THJXB3DJOtherTXOPTICARE
019163701MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050129000112 TX Practitioner - Optometry 9931159746 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
84.26 of 100Reported as group
Quality
74.27
Improvement activities
40
Cost
78.06

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05059TXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Med Southwest, PLLC Optometrist Current Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Jun 21, 2022 Accepting new patients
Med Southwest, PLLC Optometrist CurrentSince Oct 27, 2023 Accepting new patients
First Texas Optometric PC Optometrist CurrentSince Oct 13, 2023 Accepting new patients
Med Southwest, PLLC Optometrist CurrentSince Oct 27, 2023 Accepting new patients
First Texas Optometric PC Optometrist CurrentSince Oct 13, 2023 Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Jun 21, 2022 Accepting new patients
Vision Essence Inc. Optometrist CurrentSince May 29, 2012 Accepting new patients
Aeg Texas Professional PLLC Optometrist CurrentSince Nov 1, 2023 Accepting new patients
Brownwood Optometrists, P.C. Optometrist CurrentSince Oct 13, 2023 Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital Current Accepting new patients
Janet B Ogletree OD PA Optometrist PastSince Nov 1, 2016 Accepting new patients

Locations

3333 Quality Dr
Rncho Cordova, CA 95670
Phone (704) 712-0564

6 Road 7586
Bloomfield, NM 87413
Phone (505) 368-8015

1329 W Davis St
Conroe, TX 77304
Phone (936) 441-3937

310 Early Blvd
Early, TX 76802
Phone (325) 643-1826

3551 Justin Rd
Ste 150
Flower Mound, TX 75028
Phone (210) 490-9205

7586 W Bellfort Ave
Houston, TX 77071
Phone (713) 647-0864

300 Northpark Dr
Ste 600
Kingwood, TX 77339
Phone (281) 360-1006

2401 N 16th St
Orange, TX 77630
Phone (409) 886-2292

2703 Richmond Rd
Texarkana, TX 75503
Phone (903) 838-0783

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308614400000",
    "number": "1417975368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 300997",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772300997",
            "telephone_number": "713-647-0864",
            "fax_number": "713-647-0867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MEMORIAL CITY WAY",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770242599",
            "telephone_number": "713-647-0864",
            "fax_number": "713-772-4004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYOWHEOMA",
        "first_name": "IKAEHOTA",
        "middle_name": "AIGBIVBALU",
        "credential": "O.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2011-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "05059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTICARE",
            "identifier": "THJXB3DJ",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019163701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.