Healthcare Provider Details

I. General information

NPI: 1063542199
Provider Name (Legal Business Name): STACY G PRESLEY OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 ARLINGTON ST
ADA OK
74820-2636
US

IV. Provider business mailing address

1433 ARLINGTON ST
ADA OK
74820-2636
US

V. Phone/Fax

Practice location:
  • Phone: 580-332-5606
  • Fax: 580-332-3946
Mailing address:
  • Phone: 580-332-5606
  • Fax: 580-332-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2431
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2431
License Number StateOK

VIII. Authorized Official

Name: MRS. STACY G PRESLEY
Title or Position: OWNER
Credential: OD
Phone: 580-332-5606