Provider Demographics
NPI:1568562478
Name:ADEGITE, AKINTUNDE (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:AKINTUNDE
Middle Name:
Last Name:ADEGITE
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:
Other - Last Name:ADEGITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTOMETRIST
Mailing Address - Street 1:306 S LAKE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5620
Mailing Address - Country:US
Mailing Address - Phone:505-326-0552
Mailing Address - Fax:505-326-3308
Practice Address - Street 1:306 SOUTH LAKE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-326-0552
Practice Address - Fax:505-326-3308
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM2399152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist