Provider Demographics
NPI:1750687562
Name:UKEGBU, OGECHI N (OD)
Entity Type:Individual
Prefix:DR
First Name:OGECHI
Middle Name:N
Last Name:UKEGBU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:920 REVOLUTION ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3748
Practice Address - Country:US
Practice Address - Phone:410-939-2200
Practice Address - Fax:410-939-5980
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPOP96152W00000X
CT3244152W00000X
GAOPT003491152W00000X
TX8263152W00000X
MDTA2219152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist