Provider Demographics
NPI:1992961486
Name:OCHOA, DEMIAN JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:DEMIAN
Middle Name:JOHN
Last Name:OCHOA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:133 PHINNEYS LN
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-2949
Mailing Address - Country:US
Mailing Address - Phone:215-913-3321
Mailing Address - Fax:
Practice Address - Street 1:137 TEATICKET HWY
Practice Address - Street 2:INSIDE WAL-MART VISION CENTER
Practice Address - City:TEATICKET
Practice Address - State:MA
Practice Address - Zip Code:02536-5659
Practice Address - Country:US
Practice Address - Phone:508-548-2147
Practice Address - Fax:508-457-6477
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4695152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0007149Medicare PIN