Provider Demographics
NPI:1174604250
Name:UKWADE, MICHAEL TOJAKE (OD, PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TOJAKE
Last Name:UKWADE
Suffix:
Gender:M
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 BAY AREA BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-1565
Mailing Address - Country:US
Mailing Address - Phone:281-488-4774
Mailing Address - Fax:281-488-4775
Practice Address - Street 1:2402 BAY AREA BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-1565
Practice Address - Country:US
Practice Address - Phone:281-488-4774
Practice Address - Fax:281-488-4775
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4037TG152W00000X
TXTX4037174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
81019QOtherBLUECROSS BLUESHIELD
TXTX4037OtherECPA
TX04037OtherVISION BENEFITS OF AMERIC
TX4037OtherEYEMED
26172OtherSPECTERA
50739OtherDAVIS VISION
PIN 33752OtherAVESIS
TX4037OtherEYEMED
TX8CO717Medicare ID - Type Unspecified