Provider Demographics
NPI:1477514602
Name:O'DAY, DAVID G (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:O'DAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 LONE TREE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8170
Mailing Address - Country:US
Mailing Address - Phone:843-856-5275
Mailing Address - Fax:843-856-8953
Practice Address - Street 1:574 LONE TREE DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8170
Practice Address - Country:US
Practice Address - Phone:843-856-5275
Practice Address - Fax:843-856-8953
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18999207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC571089770OtherTAX ID
SCGP2889Medicaid
SCF43971Medicare UPIN
SCGP2889Medicaid