Provider Demographics
NPI:1114000577
Name:CHUKWUEKE, THEOPHILUS O (MD)
Entity Type:Individual
Prefix:
First Name:THEOPHILUS
Middle Name:O
Last Name:CHUKWUEKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S TWIN CITY HWY
Mailing Address - Street 2:STE B
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-4206
Mailing Address - Country:US
Mailing Address - Phone:409-883-4500
Mailing Address - Fax:
Practice Address - Street 1:2801 MACARTHUR DR
Practice Address - Street 2:STE B
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-4703
Practice Address - Country:US
Practice Address - Phone:409-883-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6824207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G54699Medicare UPIN