MEDICARE: DR. TRAVIS G GITTINS O.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	152W00000X	Optometrist	2242	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	429430394002	OTHER	OK	BCBS

General Provider Information

NPI Number	:	1518974641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRAVIS G GITTINS O.D.

Provider Business Mailing Address
First Line	:	8812 N COUNCIL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-3246
Country	:	US
Telephone Number	:	405-773-3937
Fax Number	:	405-728-3939

Provider Business Practice Location Address
First Line	:	8812 N COUNCIL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-3246
Country	:	US
Telephone Number	:	405-773-3937
Fax Number	:	405-728-3939

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	06/03/2021

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