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General NPI Number Information
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NPI Number | 1710043708
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Entity Type | Organization
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Legal Business Name | WALT P. MEGOWN OD INC.
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 916 E 8TH ST
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City | OKMULGEE
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State | OK
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Zip | 74447-4724
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Country | US
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Telephone | 918-756-2124
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Fax | 918-756-3865
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Provider Business Mailing Address
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Address Line | PO BOX 610
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City | OKMULGEE
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State | OK
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Zip | 74447-0610
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Country | US
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Telephone | 918-756-2124
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Fax | 918-756-3865
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Authorized Official
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Title or Position | OWNER
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Name | DR. WALT P MEGOWN
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Credential | OD
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Telephone | 918-756-2124
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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 | 880
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License Number State | OK
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