Provider Demographics
NPI:1902894470
Name:OSIKA, JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:OSIKA
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:P.O. BOX 38
Mailing Address - Street 2:HU HU KAM MEMORIAL HOSPITAL
Mailing Address - City:SACATON
Mailing Address - State:AZ
Mailing Address - Zip Code:85147-0038
Mailing Address - Country:US
Mailing Address - Phone:602-528-1200
Mailing Address - Fax:602-528-1255
Practice Address - Street 1:483 W. SEED FARM RD.
Practice Address - Street 2:HU HU KAM MEMORIAL HOSPITAL
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85147-0038
Practice Address - Country:US
Practice Address - Phone:602-528-1200
Practice Address - Fax:602-528-1255
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1105152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU82366Medicare UPIN
AZ63361Medicare ID - Type UnspecifiedMEDICARE/MEDICAID NUMBERS