MEDICARE: DAVID L EPP OD

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	2012	OK
2	152W00000X	Optometrist	04257T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	73-1440033	OTHER	OK	FED ID #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548204621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID L EPP OD

Provider Business Mailing Address
First Line	:	104 E MAIN ST
Second Line	:	PO BOX 278
City	:	SAYRE
State	:	OK
Zip	:	73662-2914
Country	:	US
Telephone Number	:	580-928-2212
Fax Number	:	580-928-2303

Provider Business Practice Location Address
First Line	:	102 E MAIN ST
Second Line	:
City	:	SAYRE
State	:	OK
Zip	:	73662-2914
Country	:	US
Telephone Number	:	580-928-2212
Fax Number	:	580-928-2303

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	12/05/2016

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Directions to “ DAVID L EPP OD” Practice Location

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