Provider Demographics
NPI:1689704538
Name:ANEKE, CHARLES OKECHUKWU (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:OKECHUKWU
Last Name:ANEKE
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 1:1305 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1736
Mailing Address - Country:US
Mailing Address - Phone:301-808-4894
Mailing Address - Fax:202-797-9098
Practice Address - Street 1:1305 WATERFORD DR
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-1736
Practice Address - Country:US
Practice Address - Phone:301-808-4894
Practice Address - Fax:202-797-9098
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOP643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD919056Medicare UPIN
599938Medicare ID - Type Unspecified