Healthcare Provider Details

I. General information

NPI: 1073575072
Provider Name (Legal Business Name): MICHAEL JOSEPH HAMPTON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 PROFESSIONAL CIR
YUKON OK
73099-6314
US

IV. Provider business mailing address

1604 PROFESSIONAL CIR
YUKON OK
73099-6314
US

V. Phone/Fax

Practice location:
  • Phone: 405-354-3624
  • Fax: 405-350-7512
Mailing address:
  • Phone: 405-354-3624
  • Fax: 405-350-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1109
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: