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General NPI Number Information
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NPI Number | 1518919299
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Entity Type | Individual
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Provider Name | LANITA R THOMAS O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 12406 E 86TH ST N
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City | OWASSO
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State | OK
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Zip | 74055-2500
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Country | US
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Telephone | 918-376-2700
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Fax | 918-376-2722
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Provider Business Mailing Address
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Address Line | 12406 E 86TH ST N
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City | OWASSO
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State | OK
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Zip | 74055-2500
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Country | US
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Telephone | 918-376-2700
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Fax | 918-376-2722
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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 | 2214
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License Number State | OK
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