Provider Demographics
NPI:1043382450
Name:NNABUE, ALEXANDER CHUKWUEMEKA (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:CHUKWUEMEKA
Last Name:NNABUE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:ALEXANDER
Other - Middle Name:CHUKWUEMEKA
Other - Last Name:NNABUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:317 HAVILAND MILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-2312
Mailing Address - Country:US
Mailing Address - Phone:301-324-9500
Mailing Address - Fax:301-324-9502
Practice Address - Street 1:10240 LAKE ARBOR WAY
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-3113
Practice Address - Country:US
Practice Address - Phone:301-324-9500
Practice Address - Fax:301-324-9502
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1277152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC026458100Medicaid
MD69074150Medicaid
MD690741500Medicaid
MD813175Medicare ID - Type Unspecified
MD690741500Medicaid
DC813175Medicare PIN