Destiny Mbidoaka, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

10501TG Issued in TX

Practice address

8894 Gateway N Blvd
El Paso, TX 79904

Phone

(915) 747-7960

NPI assigned

Mar 2, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Aeg Texas Professional PLLC

  • Optometrist
  • Kerrville, TX
  • NPI 1457905937
  Medicare reassignment NPD
• Janet B Ogletree OD PA

  • Optometrist
  • Flower Mound, TX
  • NPI 1740313089
  NPD (past)

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

{
    "created_epoch": "1646179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1942957683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 4TH ST STE 440",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026206",
            "telephone_number": "618-462-9818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8894 GATEWAY N BLVD",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79904",
            "telephone_number": "915-747-7960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MBIDOAKA",
        "first_name": "DESTINY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-02",
        "last_updated": "2023-03-01",
        "certification_date": "2023-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "10501TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Eugenia Mayorga
• Meghan Cassidy Mays, AGACNP-BC
• MB Care LLC
• Mireille Mehmeh Mbah, MD
• Anualita Mbarusha
• Matilda Ngob Mbua, FNP
• MC Crory Pharmacy, Inc
• Aishah MC Daniel
• MC-Advanced Wound Care PA
• Michelle Helen McAden, DMD

• Optometrist in El Paso, TX
• Providers in El Paso, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.