Provider Demographics
NPI:1588929863
Name:ODA, YUKIKO (OD)
Entity type:Individual
Prefix:DR
First Name:YUKIKO
Middle Name:
Last Name:ODA
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 1:400 WATER ST STE 105
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-3001
Mailing Address - Country:US
Mailing Address - Phone:937-418-7271
Mailing Address - Fax:
Practice Address - Street 1:400 WATER ST STE 105
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-3001
Practice Address - Country:US
Practice Address - Phone:937-418-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6151152W00000X
MN3492152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0071995Medicaid