Healthcare Provider Details

I. General information

NPI: 1619528981
Provider Name (Legal Business Name): EMMANUEL O OKALA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 10/25/2020
Certification Date: 10/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CONNECTICUT AVE NW
WASHINGTON DC
20036-4101
US

IV. Provider business mailing address

1100 CONNECTICUT AVE NW
WASHINGTON DC
20036-4101
US

V. Phone/Fax

Practice location:
  • Phone: 202-223-1050
  • Fax:
Mailing address:
  • Phone: 202-223-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number009054
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP1000410
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: