Provider Demographics
NPI:1275974214
Name:ODA, SCOTT MIKIO (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MIKIO
Last Name:ODA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:13399 NEWCASTLE COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3290
Mailing Address - Country:US
Mailing Address - Phone:408-768-8752
Mailing Address - Fax:
Practice Address - Street 1:13399 NEWCASTLE COMMONS DR
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98059-3290
Practice Address - Country:US
Practice Address - Phone:408-768-8752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-06
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60381388152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist