Healthcare Provider Details

I. General information

NPI: 1013173715
Provider Name (Legal Business Name): MARTIN DEE O'DONNELL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15951 LITTLE AXE DR
NORMAN OK
73026-9088
US

IV. Provider business mailing address

PO BOX 897
HOLDENVILLE OK
74848-0897
US

V. Phone/Fax

Practice location:
  • Phone: 405-447-0300
  • Fax:
Mailing address:
  • Phone: 405-379-2020
  • Fax: 405-379-2019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number2576
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2576
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number2576
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2576
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number2576
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number2576
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: