Provider Demographics
NPI:1952443483
Name:NDUDIM, NKEIRU MELISSAH (DO)
Entity Type:Individual
Prefix:DR
First Name:NKEIRU
Middle Name:MELISSAH
Last Name:NDUDIM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4915 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5707
Mailing Address - Country:US
Mailing Address - Phone:209-956-3323
Mailing Address - Fax:209-956-3323
Practice Address - Street 1:10349 GRACIOSA WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-3464
Practice Address - Country:US
Practice Address - Phone:916-686-4833
Practice Address - Fax:916-567-0803
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13203T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist