Provider Demographics
NPI:1831281575
Name:OATES, DANA JEAN (OD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:JEAN
Last Name:OATES
Suffix:
Gender:F
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:419-673-8652
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:419-673-8652
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4451152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2241578Medicaid
OH341214040029OtherCARESOURCE
OH2241578Medicaid
OH0197100001Medicare NSC
OH0780454Medicare ID - Type Unspecified