Provider Demographics
NPI:1912389446
Name:EKPO, UTANG (OD)
Entity Type:Individual
Prefix:
First Name:UTANG
Middle Name:
Last Name:EKPO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3679 N VERMILION ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-1167
Mailing Address - Country:US
Mailing Address - Phone:217-213-6264
Mailing Address - Fax:217-213-6312
Practice Address - Street 1:3679 N VERMILION ST
Practice Address - Street 2:SUITE A
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-1167
Practice Address - Country:US
Practice Address - Phone:217-213-6264
Practice Address - Fax:217-213-6312
Is Sole Proprietor?:No
Enumeration Date:2015-06-20
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL046011055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist