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General NPI Number Information
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NPI Number | 1629504535
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Entity Type | Individual
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Provider Name | ONYEKACHUKWU ILLOH OD, MPH
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Gender | Female
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 03/31/2023
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Provider Practice Location Address
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Address Line | 1924 8TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20001-3286
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Country | US
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Telephone | 202-602-1745
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Fax |
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Provider Business Mailing Address
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Address Line | 10903 NEW HAMPSHIRE AVE BUILDING 22, ROOM 3409
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City | SILVER SPRING
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State | MD
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Zip | 20993-0002
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Country | US
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Telephone | 301-796-7572
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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 | TA2698
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OP1000350
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License Number State | DC
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