Provider Demographics
NPI:1669447553
Name:OATES, TODD W (OD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:W
Last Name:OATES
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 1:315 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-1575
Mailing Address - Country:US
Mailing Address - Phone:419-673-5201
Mailing Address - Fax:
Practice Address - Street 1:315 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1575
Practice Address - Country:US
Practice Address - Phone:419-673-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4486152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341214040027OtherCARESOURCE
OH2241461Medicaid
OH341214040027OtherCARESOURCE
OHU45963Medicare UPIN
OH0197100001Medicare NSC