MEDICARE: DARRELL J PICKARD 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	18401	OK

General Provider Information

NPI Number	:	1336118769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRELL J PICKARD M.D.

Provider Business Mailing Address
First Line	:	1455 S DOUGLAS BLVD
Second Line	:	SUITE D
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5268
Country	:	US
Telephone Number	:	405-733-4545
Fax Number	:	705-733-2758

Provider Business Practice Location Address
First Line	:	1455 S DOUGLAS BLVD
Second Line	:	SUITE D
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5268
Country	:	US
Telephone Number	:	405-733-4545
Fax Number	:	405-733-2758

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	03/07/2011

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