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General NPI Number Information
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NPI Number | 1205017779
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Entity Type | Organization
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Legal Business Name | TONYA WARD JACKSON OD PC
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 04/16/2009
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Provider Practice Location Address
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Address Line | 8010 S 101ST EAST AVE SUITE 100
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City | TULSA
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State | OK
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Zip | 74133-4562
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Country | US
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Telephone | 918-252-7432
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Fax | 918-250-9003
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Provider Business Mailing Address
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Address Line | 8010 S 101ST EAST AVE SUITE 100
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City | TULSA
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State | OK
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Zip | 74133-4562
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Country | US
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Telephone | 918-252-7432
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Fax | 918-250-9003
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. TONYA W JACKSON
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Credential | OD
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Telephone | 918-252-7432
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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 | 1196
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License Number State | OK
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