Healthcare Provider Details

I. General information

NPI: 1851321475
Provider Name (Legal Business Name): HARRY LAYTON CPO, LPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 W GORE BLVD
LAWTON OK
73505-6319
US

IV. Provider business mailing address

2724 W GORE BLVD
LAWTON OK
73505-6319
US

V. Phone/Fax

Practice location:
  • Phone: 580-353-5525
  • Fax: 580-353-5523
Mailing address:
  • Phone: 580-353-5525
  • Fax: 580-353-5523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberLPO46
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberLPO46
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: