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NPI Code Detail

MEDICARE: DR. OSAMEDE SUNDAY ODIASE O.D

MEDICARE: DR. OSAMEDE SUNDAY ODIASE O.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist13373TCA

General Provider Information

NPI Number : 1891983219
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. OSAMEDE SUNDAY ODIASE O.D
Provider Business Mailing Address
First Line : 2044 FOREST AVE
Second Line :
City : CHICO
State : CA
Zip : 95928-7619
Country : US
Telephone Number : 530-899-8175
Fax Number : 530-899-1166
Provider Business Practice Location Address
First Line : 2044 FOREST AVE
Second Line :
City : CHICO
State : CA
Zip : 95928-7619
Country : US
Telephone Number : 530-899-8175
Fax Number : 530-899-1166
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2007
Last Update Date : 06/19/2015

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