Provider Demographics
NPI:1740269166
Name:EKENNA-KALU, CHIDIEBERE UZOMA (OD, PHD)
Entity type:Individual
Prefix:DR
First Name:CHIDIEBERE
Middle Name:UZOMA
Last Name:EKENNA-KALU
Suffix:
Gender:F
Credentials:OD, PHD
Other - Prefix:MISS
Other - First Name:CHIDI
Other - Middle Name:UZOMA
Other - Last Name:EKENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 43145
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31704-3145
Mailing Address - Country:US
Mailing Address - Phone:850-206-7900
Mailing Address - Fax:
Practice Address - Street 1:814 RADFORD BLVD
Practice Address - Street 2:BLDG 7000
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31704-1130
Practice Address - Country:US
Practice Address - Phone:229-639-5980
Practice Address - Fax:229-639-7847
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1158DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist