Provider Demographics
NPI:1457696270
Name:ANTWI, AFUA WIREKOA (OD)
Entity type:Individual
Prefix:DR
First Name:AFUA
Middle Name:WIREKOA
Last Name:ANTWI
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 1:262 PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-2018
Mailing Address - Country:US
Mailing Address - Phone:860-206-8818
Mailing Address - Fax:860-206-4876
Practice Address - Street 1:262 PARK RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-2018
Practice Address - Country:US
Practice Address - Phone:860-206-8818
Practice Address - Fax:860-206-4876
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002871152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008043639Medicaid