Provider Demographics
NPI:1104101260
Name:AKANO, OBINNA FERDINAND (OD, DRPH)
Entity type:Individual
Prefix:DR
First Name:OBINNA
Middle Name:FERDINAND
Last Name:AKANO
Suffix:
Gender:M
Credentials:OD, DRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2742A E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2808
Mailing Address - Country:US
Mailing Address - Phone:718-684-5634
Mailing Address - Fax:380-333-9618
Practice Address - Street 1:2742A E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2808
Practice Address - Country:US
Practice Address - Phone:718-684-5634
Practice Address - Fax:380-333-9618
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03454515Medicaid
NY03454515Medicaid