Provider Demographics
NPI:1891983219
Name:ODIASE, OSAMEDE SUNDAY (OD)
Entity Type:Individual
Prefix:DR
First Name:OSAMEDE
Middle Name:SUNDAY
Last Name:ODIASE
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 1:2044 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7619
Mailing Address - Country:US
Mailing Address - Phone:530-899-8175
Mailing Address - Fax:530-899-1166
Practice Address - Street 1:2044 FOREST AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7619
Practice Address - Country:US
Practice Address - Phone:530-899-8175
Practice Address - Fax:530-899-1166
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13373T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA138269Medicare PIN