Individual
CHISOM IWUANYANWU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D
Contact information
Practice address
217 14 MERRICK BLVD, LAURELTON, NY 11413-1726
(718) 978-0100
Mailing address
217 14 MERRICK BLVD, LAURELTON, NY 11413-1726
(718) 978-0100
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV007637-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03556163
—
NY
Enumeration date
12/09/2010
Last updated
06/11/2024
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