Healthcare Provider Details

I. General information

NPI: 1952476566
Provider Name (Legal Business Name): LARRY KENNETH SILKEY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SW GOODYEAR BLVD
LAWTON OK
73505-9755
US

IV. Provider business mailing address

40 BURTON HILLS BLVD SUITE 200
NASHVILLE TN
37215-6155
US

V. Phone/Fax

Practice location:
  • Phone: 580-510-6361
  • Fax: 580-531-5779
Mailing address:
  • Phone: 615-565-1733
  • Fax: 615-296-0151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1116
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: