Provider Demographics
NPI:1902958473
Name:ODRICH, STEVEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:ODRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3765 RIVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1845
Mailing Address - Country:US
Mailing Address - Phone:718-432-2020
Mailing Address - Fax:718-432-8482
Practice Address - Street 1:3765 RIVERDALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1845
Practice Address - Country:US
Practice Address - Phone:718-432-2020
Practice Address - Fax:718-432-8482
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179385207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0052450OtherGHI
NYP452672OtherOXFORD
NY1120632OtherUNITED HEALTHCARE
NY7934148OtherCIGNA
NY01444600Medicaid
NYA400000402Medicare PIN
NY0052450OtherGHI