Provider Demographics
NPI:1780637256
Name:ODA, JOANNA J (MD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:J
Last Name:ODA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S OYSTER BAY RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3500
Mailing Address - Country:US
Mailing Address - Phone:516-939-6100
Mailing Address - Fax:516-939-2510
Practice Address - Street 1:400 S OYSTER BAY RD
Practice Address - Street 2:SUITE 305
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3500
Practice Address - Country:US
Practice Address - Phone:516-939-6100
Practice Address - Fax:516-939-2510
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD63313207W00000X
NY244872207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02914914Medicaid
MD408613900Medicaid
NY098751OtherMEDICARE PROVIDER ID
NY02914914Medicaid
NYI42596Medicare UPIN