Provider Demographics
NPI:1265137947
Name:OJEDA, STORM SANDRA (OPTICIAN)
Entity type:Individual
Prefix:MS
First Name:STORM
Middle Name:SANDRA
Last Name:OJEDA
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-2229
Mailing Address - Country:US
Mailing Address - Phone:518-308-7304
Mailing Address - Fax:
Practice Address - Street 1:2344 BROADWAY
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-2229
Practice Address - Country:US
Practice Address - Phone:518-308-7304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010371156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician