Provider Demographics
NPI:1578672549
Name:OTOJARE, CHINYE MUKOSOLU (OD)
Entity type:Individual
Prefix:DR
First Name:CHINYE
Middle Name:MUKOSOLU
Last Name:OTOJARE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 PETERSON RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-8953
Mailing Address - Country:US
Mailing Address - Phone:302-609-0041
Mailing Address - Fax:
Practice Address - Street 1:1207 N SCOTT ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4059
Practice Address - Country:US
Practice Address - Phone:302-652-3353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002708152W00000X
MDTA1921152W00000X
DEI3-0001390152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE532312ZAPWMedicare PIN