Provider Demographics
NPI:1164757936
Name:OGUNDIPE, OLUTOYIN (MD, FWACS, FMCO)
Entity Type:Individual
Prefix:DR
First Name:OLUTOYIN
Middle Name:
Last Name:OGUNDIPE
Suffix:
Gender:F
Credentials:MD, FWACS, FMCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5921 VISTA VERDE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6976
Mailing Address - Country:US
Mailing Address - Phone:704-583-1290
Mailing Address - Fax:866-262-7969
Practice Address - Street 1:4 ADEYERI CLOSE
Practice Address - Street 2:OFF OPEBI STREET
Practice Address - City:IKEJA
Practice Address - State:LAGOS
Practice Address - Zip Code:100001
Practice Address - Country:NG
Practice Address - Phone:0112341-892-2647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ2897152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist