=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609066596
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNSEY ANN BIGHEART O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2007
-----------------------------------------------------
Last Update Date | 07/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4520 S HARVARD AVE SUITE 135
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74135-2925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-745-9662
-----------------------------------------------------
Fax | 918-745-9663
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4520 S HARVARD AVE SUITE 135
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74135-2925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-745-9662
-----------------------------------------------------
Fax | 918-745-9663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2510
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------