Provider Demographics
NPI:1427289248
Name:AWOSIKA, IDOWU OLUWASEUN (OD)
Entity type:Individual
Prefix:DR
First Name:IDOWU
Middle Name:OLUWASEUN
Last Name:AWOSIKA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WAL MART WAY
Mailing Address - Street 2:STE 5
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-7516
Mailing Address - Country:US
Mailing Address - Phone:606-759-0030
Mailing Address - Fax:606-759-0030
Practice Address - Street 1:240 WAL MART WAY
Practice Address - Street 2:STE 5
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-7516
Practice Address - Country:US
Practice Address - Phone:606-759-0030
Practice Address - Fax:606-759-0030
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1776DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100097640Medicaid