Provider Demographics
NPI:1952357527
Name:MUNONYEDI, SAMUEL UBA (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:UBA
Last Name:MUNONYEDI
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 1:1588 REMSEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5214
Mailing Address - Country:US
Mailing Address - Phone:718-604-1002
Mailing Address - Fax:718-604-1027
Practice Address - Street 1:847 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-1338
Practice Address - Country:US
Practice Address - Phone:718-604-1002
Practice Address - Fax:718-604-1027
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006276152W00000X
NJ27OA00579100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02079638Medicaid
NY925287OtherBLOCKVISION
NY52937OtherDAVIS VISION
NY02079638Medicaid
NYC451H1Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY04568Medicare ID - Type UnspecifiedGHI MEDICARE