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General NPI Number Information
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NPI Number | 1194070490
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Entity Type | Individual
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Provider Name | VIVIAN OWANIMEDU EKEMEZIE O.D
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Gender | Female
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 825 NICOLLET MALL
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City | MINNEAPOLIS
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State | MN
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Zip | 55402-2606
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Country | US
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Telephone | 612-338-4861
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Fax | 612-333-8306
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Provider Business Mailing Address
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Address Line | 9113 ASHLEY TER
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City | BROOKLYN PARK
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State | MN
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Zip | 55443-1714
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3311
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License Number State | MN
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