Healthcare Provider Details

I. General information

NPI: 1730700303
Provider Name (Legal Business Name): WAMIKA KUMAR OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W UNIVERSITY BLVD
DURANT OK
74701-3098
US

IV. Provider business mailing address

1901 W UNIVERSITY BLVD
DURANT OK
74701-3098
US

V. Phone/Fax

Practice location:
  • Phone: 580-920-2020
  • Fax:
Mailing address:
  • Phone: 580-920-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10125
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3081
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: