Provider Demographics
NPI:1609827765
Name:EKUKPE, IREDIA JOE (OD)
Entity Type:Individual
Prefix:DR
First Name:IREDIA
Middle Name:JOE
Last Name:EKUKPE
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 1:655 W ILLINOIS AVE
Mailing Address - Street 2:#911
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-1817
Mailing Address - Country:US
Mailing Address - Phone:214-941-9600
Mailing Address - Fax:214-941-9623
Practice Address - Street 1:655 W ILLINOIS AVE
Practice Address - Street 2:#911
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-1817
Practice Address - Country:US
Practice Address - Phone:214-941-9600
Practice Address - Fax:214-941-9623
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6330TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU92940Medicare UPIN