Provider Demographics
NPI:1861421695
Name:NWOKEDI, EMEKA VINCENT (OD)
Entity type:Individual
Prefix:DR
First Name:EMEKA
Middle Name:VINCENT
Last Name:NWOKEDI
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 1:11255 GARLAND RD
Mailing Address - Street 2:STE. 1130
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2526
Mailing Address - Country:US
Mailing Address - Phone:214-575-7668
Mailing Address - Fax:214-660-7071
Practice Address - Street 1:11255 GARLAND RD
Practice Address - Street 2:STE. 1130
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2526
Practice Address - Country:US
Practice Address - Phone:214-575-7668
Practice Address - Fax:214-660-7071
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06476T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178712901Medicaid
TXV03163Medicare UPIN
TX178712901Medicaid