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NPI Code Detail

MEDICARE: JOSEPHINE OLUTOLA IBIRONKE O.D.

MEDICARE: JOSEPHINE OLUTOLA IBIRONKE O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristTA1877MD
2152W00000XOptometrist2041DTKY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831145770
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPHINE OLUTOLA IBIRONKE O.D.
Provider Business Mailing Address
First Line : 147 SYCAMORE ST
Second Line :
City : PIKEVILLE
State : KY
Zip : 41501-9118
Country : US
Telephone Number : 606-218-5525
Fax Number :
Provider Business Practice Location Address
First Line : 147 SYCAMORE ST
Second Line :
City : PIKEVILLE
State : KY
Zip : 41501-9118
Country : US
Telephone Number : 606-218-5525
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2006
Last Update Date : 07/20/2022

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