Provider Demographics
NPI:1679986913
Name:ONYEKWELU, STELLA
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:ONYEKWELU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 WESTCLIFF CIR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8899
Mailing Address - Country:US
Mailing Address - Phone:618-741-3715
Mailing Address - Fax:
Practice Address - Street 1:502 BOOTH RD
Practice Address - Street 2:(INSIDE WALMART VISION CENTER)
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-3422
Practice Address - Country:US
Practice Address - Phone:478-918-0636
Practice Address - Fax:478-918-0683
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002814152W00000X, 152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy