Individual provider Active NPI

Apeameokhai Philip Aitsebaomo, OD PHD

  • Optometrist
  • Houston, TX
National Provider Identifier
1710980438
Registry record updated Jan 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3114TG Issued in TX
Practice address
12401 South Post Oak
Suite D
Houston, TX 77045
Phone
(713) 721-9000
Fax
(713) 721-9002
NPI assigned
May 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3114TG TX Primary

Addresses

Primary practice location

12401 South Post Oak
Suite D
Houston, TX 77045

Mailing address

PO Box 25275
Houston, TX 77265
Phone (713) 721-9000

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
I20051110000671 TX Practitioner - Optometry 2668490319 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
3114TXMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
University of the Incarnate Word Optometrist CurrentSince Jun 1, 2015 Accepting new patients
University of the Incarnate Word CurrentSince Jun 1, 2015 Accepting new patients
Urban Eye Associates PC Optometrist PastSince Feb 21, 2010 Accepting new patients
John J. Perez, O.D., P.C Optometrist Past Accepting new patients

Locations

9725 Datapoint Dr
San Antonio, TX 78229
Phone (210) 283-6800

9725 Datapoint Dr
#69
San Antonio, TX 78229
Phone (210) 283-6800

Organizations & group practices 4

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": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200268800000",
    "number": "1710980438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25275",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77265",
            "telephone_number": "713-721-9000",
            "fax_number": "713-721-9002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12401 SOUTH POST OAK",
            "address_2": "SUITE D",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77045",
            "telephone_number": "713-721-9000",
            "fax_number": "713-721-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AITSEBAOMO",
        "first_name": "APEAMEOKHAI",
        "middle_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "OD PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2008-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "3114TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.