Provider Demographics
NPI:1619528981
Name:OKALA, EMMANUEL O (OD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:O
Last Name:OKALA
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 1:1100 CONNECTICUT AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-4101
Mailing Address - Country:US
Mailing Address - Phone:202-223-1050
Mailing Address - Fax:
Practice Address - Street 1:1100 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4101
Practice Address - Country:US
Practice Address - Phone:202-223-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009054152W00000X
DCOP1000410152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty