Healthcare Provider Details

I. General information

NPI: 1891585501
Provider Name (Legal Business Name): HAYDEN ALEXIS HARNESS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HAYDEN ALEXIS KIMBERLAND

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471688 SH-51
STILWELL OK
74960
US

IV. Provider business mailing address

1519 CREEKSIDE DR
TAHLEQUAH OK
74464-6239
US

V. Phone/Fax

Practice location:
  • Phone: 918-696-8800
  • Fax:
Mailing address:
  • Phone: 479-670-3275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3302
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: