Healthcare Provider Details

I. General information

NPI: 1891952453
Provider Name (Legal Business Name): JACQUELYN POWERS OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3539 W MAIN ST
NORMAN OK
73072-4811
US

IV. Provider business mailing address

3539 W MAIN ST
NORMAN OK
73072-4811
US

V. Phone/Fax

Practice location:
  • Phone: 185-275-2109
  • Fax:
Mailing address:
  • Phone: 918-527-5210
  • Fax: 405-364-3269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2496
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number2496
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number2496
License Number StateOK

VIII. Authorized Official

Name: JACQUELYN POWERS
Title or Position: OWNER
Credential:
Phone: 918-527-5210