Provider Demographics
NPI:1720290612
Name:EBUBE, EZEAGWULA CHIKWENDU (OD)
Entity Type:Individual
Prefix:DR
First Name:EZEAGWULA
Middle Name:CHIKWENDU
Last Name:EBUBE
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:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0938
Mailing Address - Country:US
Mailing Address - Phone:787-876-5511
Mailing Address - Fax:787-876-5511
Practice Address - Street 1:EYE EXPRESS 20-20, PLAZA RIAL 185, KM .9
Practice Address - Street 2:SUITE # 3
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-876-5511
Practice Address - Fax:787-876-5511
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR167152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR58085OtherTRIPLE S
PR0688OtherFIRST MEDICAL
PR6290051OtherHUMANA
PR6290051OtherHUMANA
PR077041OtherCRUZ AZUL
PR068-167OtherGLOBAL HEALTH
PR0688OtherFIRST MEDICAL