MEDICARE: PAMELA J POLAND M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	17919	OK

General Provider Information

NPI Number	:	1285639781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA J POLAND M.D.

Provider Business Mailing Address
First Line	:	400 FAIRVIEW AVE
Second Line	:	STE 18
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1920
Country	:	US
Telephone Number	:	580-762-5696
Fax Number	:	580-762-7622

Provider Business Practice Location Address
First Line	:	400 FAIRVIEW AVE
Second Line	:	STE 18
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1920
Country	:	US
Telephone Number	:	580-762-5696
Fax Number	:	580-762-7622

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	03/13/2013

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