Healthcare Provider Details

I. General information

NPI: 1871415497
Provider Name (Legal Business Name): KRYSTAL HOANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 W GORE BLVD
LAWTON OK
73501-3606
US

IV. Provider business mailing address

1415 W GORE BLVD
LAWTON OK
73501-3606
US

V. Phone/Fax

Practice location:
  • Phone: 580-355-3036
  • Fax: 580-248-1162
Mailing address:
  • Phone: 580-355-3036
  • Fax: 580-248-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3347
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: