MEDICARE: ALAZIGHA OWEI OD

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	152W00000X	Optometrist	34597	CA

General Provider Information

NPI Number	:	1083256697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAZIGHA OWEI OD

Provider Business Mailing Address
First Line	:	8588 ARROW RTE
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-0807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5337 HAMNER AVE UNIT 709
Second Line	:
City	:	EASTVALE
State	:	CA
Zip	:	91752-1042
Country	:	US
Telephone Number	:	951-456-0088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2019
Last Update Date	:	08/17/2020

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