Provider Demographics
NPI:1720439631
Name:ODA SUPPLY INC
Entity Type:Organization
Organization Name:ODA SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ODALIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-757-0553
Mailing Address - Street 1:2525 PONCE DE LEON BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6044
Mailing Address - Country:US
Mailing Address - Phone:786-757-0553
Mailing Address - Fax:
Practice Address - Street 1:2525 PONCE DE LEON BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6044
Practice Address - Country:US
Practice Address - Phone:786-757-0553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies