Individual
DR. VIVIAN OWANIMEDU EKEMEZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D
Contact information
Practice address
825 NICOLLET MALL, MINNEAPOLIS, MN 55402-2606
(612) 338-4861
(612) 333-8306
Mailing address
9113 ASHLEY TER, BROOKLYN PARK, MN 55443-1714
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3311
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410003852
MEDICARE PTAN
MN
01
—
H400663114
MEDICARE PTAN
MN
Enumeration date
07/23/2012
Last updated
03/14/2025
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