Healthcare Provider Details

I. General information

NPI: 1427021864
Provider Name (Legal Business Name): LAURA HILL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E 6TH ST
TISHOMINGO OK
73460-0000
US

IV. Provider business mailing address

1921 STONECIPHER BOULEVARD
ADA OK
74820-3439
US

V. Phone/Fax

Practice location:
  • Phone: 580-371-2362
  • Fax: 580-421-6210
Mailing address:
  • Phone: 580-421-4570
  • Fax: 580-421-6210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2389
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: