Provider Demographics
NPI:1508953225
Name:ONWUKWE, DOMINIC SUNDAY (OD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:SUNDAY
Last Name:ONWUKWE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 GOOD HOPE RD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3403
Mailing Address - Country:US
Mailing Address - Phone:202-627-2403
Mailing Address - Fax:202-627-2428
Practice Address - Street 1:2451 GOOD HOPE RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3203
Practice Address - Country:US
Practice Address - Phone:202-627-2403
Practice Address - Fax:202-627-2428
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 1912152W00000X
DCOP1000012152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD371SMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER