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General NPI Number Information
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NPI Number | 1134670417
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Entity Type | Organization
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Legal Business Name | L MAYES, PLLC
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 705 SW 19TH ST STE 160B
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City | MOORE
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State | OK
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Zip | 73160-3049
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Country | US
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Telephone | 405-790-0393
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Fax | 405-790-0395
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Provider Business Mailing Address
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Address Line | 1800 S CODI ST
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City | SAPULPA
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State | OK
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Zip | 74066-6617
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Country | US
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Telephone | 405-790-0393
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Fax | 405-790-0395
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Authorized Official
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Title or Position | OWNER/OPTOMETRIC PHYSICIAN
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Name | DR. LISA LYNNE MAYES
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Credential | O.D.
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Telephone | 405-790-0393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2344
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License Number State | OK
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