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General NPI Number Information
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NPI Number | 1730498890
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Entity Type | Organization
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Legal Business Name | DR ROBERT D HEAD AND DR JENNIFER L HEAD LLC ROBERT D HEAD JR SOLE MBR
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Dates
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Enumeration Date | 10/06/2010
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Last Update Date | 10/06/2010
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Provider Practice Location Address
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Address Line | 1302 SW C AVE
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City | LAWTON
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State | OK
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Zip | 73501-4243
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Country | US
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Telephone | 580-355-1298
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Fax | 580-581-7201
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Provider Business Mailing Address
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Address Line | 1302 SW C AVE
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City | LAWTON
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State | OK
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Zip | 73501-4243
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Country | US
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Telephone | 580-355-1298
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Fax | 580-581-7201
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. ROBERT DALE HEAD JR.
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Credential | O.D.
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Telephone | 580-355-1298
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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 | 1049
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License Number State | OK
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