MEDICARE: DR. ADOLPHUS CHUKWUGOZIE ANOSIKE O,D.

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	152W00000X	Optometrist	TUV004752-1	NY
2	152W00000X	Optometrist	27OAOO472300	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	222809217	OTHER	NY	VSP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396707584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADOLPHUS CHUKWUGOZIE ANOSIKE O,D.

Provider Business Mailing Address
First Line	:	117 79TH ST
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5839
Country	:	US
Telephone Number	:	201-295-0892
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3102
Country	:	US
Telephone Number	:	718-693-5994
Fax Number	:	718-693-6284

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	07/08/2007

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