=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225701733
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VALERIE ANULI OKAKPU OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2021
-----------------------------------------------------
Last Update Date | 06/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5009 LONE TREE WAY STE A
-----------------------------------------------------
City | ANTIOCH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94531-8690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-757-0450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2020 DATE ST
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94519-2516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-393-8119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG003822
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3013-IOD
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT35413-TLG
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------