MEDICARE: DR. AFUA WIREKOA ANTWI 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	152W00000X	Optometrist	002871	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457696270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AFUA WIREKOA ANTWI OD

Provider Business Mailing Address
First Line	:	262 PARK RD
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-2018
Country	:	US
Telephone Number	:	860-206-8818
Fax Number	:	860-206-4876

Provider Business Practice Location Address
First Line	:	262 PARK RD
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-2018
Country	:	US
Telephone Number	:	860-206-8818
Fax Number	:	860-206-4876

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

Provider Enumeration Date	:	12/05/2012
Last Update Date	:	02/19/2020

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