Healthcare Provider Details

I. General information

NPI: 1992330534
Provider Name (Legal Business Name): JANET POOLE NAGUIB OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4008 S ELM PL STE A
BROKEN ARROW OK
74011-2021
US

IV. Provider business mailing address

1001 N GRAND AVE
TAHLEQUAH OK
74464-7017
US

V. Phone/Fax

Practice location:
  • Phone: 918-455-2020
  • Fax:
Mailing address:
  • Phone: 918-444-4031
  • Fax: 918-458-9603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4202
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1199
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: