Healthcare Provider Details

I. General information

NPI: 1871229583
Provider Name (Legal Business Name): JARRETT L WINGFIELD OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7472 E ADMIRAL PL
TULSA OK
74115-7913
US

IV. Provider business mailing address

5312 W 41ST ST
TULSA OK
74107-6110
US

V. Phone/Fax

Practice location:
  • Phone: 918-836-2020
  • Fax: 866-834-4717
Mailing address:
  • Phone: 918-800-2020
  • Fax: 877-464-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3208
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: