Provider Demographics
NPI:1659553709
Name:CHIKWENDU, CHUKWEUMEKA (OD)
Entity Type:Individual
Prefix:
First Name:CHUKWEUMEKA
Middle Name:
Last Name:CHIKWENDU
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 1:7743 WEST LN
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3348
Mailing Address - Country:US
Mailing Address - Phone:209-636-4914
Mailing Address - Fax:209-208-1819
Practice Address - Street 1:7743 WEST LN
Practice Address - Street 2:SUITE A2
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3348
Practice Address - Country:US
Practice Address - Phone:209-636-4914
Practice Address - Fax:209-208-1819
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13449152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0134490Medicare PIN
CASD0134492Medicare PIN
CASD0134491Medicare PIN
CASD0134493Medicare PIN