Healthcare Provider Details

I. General information

NPI: 1639973167
Provider Name (Legal Business Name): PAYTON BERRY LOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14701 N SANTA FE AVE
EDMOND OK
73013-3411
US

IV. Provider business mailing address

1800 RENAISSANCE BLVD
EDMOND OK
73013-3023
US

V. Phone/Fax

Practice location:
  • Phone: 405-752-2733
  • Fax:
Mailing address:
  • Phone: 405-920-5222
  • Fax: 405-920-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3307
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: