Provider Demographics
NPI:1235607102
Name:MADUEMEZIA, NMADINAOBI (OD)
Entity Type:Individual
Prefix:DR
First Name:NMADINAOBI
Middle Name:
Last Name:MADUEMEZIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 PERPEN CT W
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5100
Mailing Address - Country:US
Mailing Address - Phone:302-256-4358
Mailing Address - Fax:
Practice Address - Street 1:1204 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-5034
Practice Address - Country:US
Practice Address - Phone:610-446-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003488152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist