Healthcare Provider Details

I. General information

NPI: 1982533832
Provider Name (Legal Business Name): CORBIN LILL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 DEWEY AVE
POTEAU OK
74953-4412
US

IV. Provider business mailing address

8500 S 36TH TER
FORT SMITH AR
72908-8880
US

V. Phone/Fax

Practice location:
  • Phone: 918-649-0524
  • Fax: 918-649-0891
Mailing address:
  • Phone: 479-242-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3354
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: