Provider Demographics
NPI:1144484858
Name:MORDI, CHIKE R (OD)
Entity type:Individual
Prefix:
First Name:CHIKE
Middle Name:R
Last Name:MORDI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4899 GRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-2855
Mailing Address - Country:US
Mailing Address - Phone:713-748-5000
Mailing Address - Fax:713-748-8707
Practice Address - Street 1:4899 GRIGGS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-2855
Practice Address - Country:US
Practice Address - Phone:713-748-5000
Practice Address - Fax:713-748-5000
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7220TG152WC0802X, 152WX0102X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206477602Medicaid
TX7220TGOtherOPTOMETRY LICENSE
TX206477602Medicaid