Provider Demographics
NPI:1831399591
Name:ETAME, ANWI (OD)
Entity type:Individual
Prefix:
First Name:ANWI
Middle Name:
Last Name:ETAME
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANWI
Other - Middle Name:
Other - Last Name:NGANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:777 TANGLEFOOT LN
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1650
Mailing Address - Country:US
Mailing Address - Phone:563-323-2020
Mailing Address - Fax:563-459-6615
Practice Address - Street 1:4731 45TH STREET CT
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-7102
Practice Address - Country:US
Practice Address - Phone:309-793-2020
Practice Address - Fax:309-792-2602
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010004152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist