Organization
VIVIAN EKEMEZIE, O.D
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIVIAN OWANIMEDU EKEMEZIE O.D (OPTOMETRIST)
(763) 843-7153
Entity
Organization
Contact information
Practice address
215 BALSAM ST N, CAMBRIDGE, MN 55008-5814
(763) 689-5576
(763) 689-3792
Mailing address
1036 97TH LN NE, BLAINE, MN 55434-3515
(763) 843-7153
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3311
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194070490
NPI 1
MN
01
—
1790029742
NPI 2
MN
01
—
410003852
MEDICARE PTAN
MN
Enumeration date
11/15/2012
Last updated
07/17/2013
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