Provider Demographics
NPI:1881066058
Name:DR N
Entity type:Organization
Organization Name:DR N
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:UGONMA
Authorized Official - Middle Name:C
Authorized Official - Last Name:NWAOHUOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-427-6861
Mailing Address - Street 1:613 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-3421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1950 ANDERSON HWY
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-7918
Practice Address - Country:US
Practice Address - Phone:804-379-0555
Practice Address - Fax:804-379-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002277152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1033470539Medicaid
VA1033470539Medicaid