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General NPI Number Information
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NPI Number | 1134857279
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Entity Type | Individual
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Provider Name | MEGAN RAE TUCKER OD
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Gender | Female
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 1200 S AIR DEPOT BLVD STE A
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City | MIDWEST CITY
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State | OK
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Zip | 73110-4848
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Country | US
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Telephone | 405-494-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 3730 E MOUNTAIN RD
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City | BARTLESVILLE
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State | OK
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Zip | 74003-6928
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Country | US
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Telephone | 918-886-0312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 3205
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License Number State | OK
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