Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2296 | NC |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2296 | NC |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 2296 | NC |
N | 152WP0200X | Pediatric Optomitrist | 2296 | NC |
NPI | 1245580984 |
---|---|
Provider Name | Dr. Yewande Olateju Alonge |
First Address | Raleigh, NC 27612-0049 |
Second Address | Raleigh, NC 27612-2657 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2012 |
Last Update Date | 02/08/2019 |