Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TA1277 | MD |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | TA1277 | MD |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | TA1277 | MD |
N | 152WP0200X | Pediatric Optomitrist | TA1277 | MD |
N | 152WS0006X | Sports Vision | TA1277 | MD |
N | 152WV0400X | Optomitrist - Vision Therapist | TA1277 | MD |
N | 152WX0102X | Occupational Vision | TA1277 | MD |
NPI | 1043382450 |
---|---|
Provider Name | Dr. Alexander Chukwuemeka Nnabue |
First Address | Brookeville, MD 20833-2312 |
Second Address | Mitchellville, MD 20721-3113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 19/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
026458100 | (05) | DC |
69074150 | (05) | MD |
690741500 | (05) | MD |
U58943 | (02) | MD |