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General NPI Number Information
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NPI Number | 1245210020
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Entity Type | Individual
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Provider Name | REBECCA LYNN POAGE OD
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Gender | Female
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 500 N FINANCIAL TER SUITE A
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City | MUSTANG
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State | OK
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Zip | 73064-4432
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Country | US
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Telephone | 405-256-0126
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Fax | 405-256-0563
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Provider Business Mailing Address
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Address Line | 1432 N MUSTANG RD STE A
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City | MUSTANG
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State | OK
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Zip | 73064-7214
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Country | US
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Telephone | 405-256-0126
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Fax | 405-256-0563
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 2430
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 2430
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 2430
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2430
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License Number State | OK
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