Provider Demographics
NPI:1740370527
Name:OFFOHA, EMMANUELLA KELECHI (OD)
Entity type:Individual
Prefix:DR
First Name:EMMANUELLA
Middle Name:KELECHI
Last Name:OFFOHA
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 1:3425 W PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4606
Mailing Address - Country:US
Mailing Address - Phone:602-504-2720
Mailing Address - Fax:602-863-4175
Practice Address - Street 1:3425 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4606
Practice Address - Country:US
Practice Address - Phone:602-504-2720
Practice Address - Fax:602-863-4175
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist