Healthcare Provider Details

I. General information

NPI: 1457458366
Provider Name (Legal Business Name): TRINA D PIPER-HUGHBANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 4TH ST STE D
ALVA OK
73717-2363
US

IV. Provider business mailing address

410 4TH ST STE D
ALVA OK
73717-2363
US

V. Phone/Fax

Practice location:
  • Phone: 580-327-3335
  • Fax:
Mailing address:
  • Phone: 58-032-7333
  • Fax: 580-327-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2165
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: