MEDICARE: DR. RALPH ALAN LATIMER 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	2307	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7061187	OTHER		AETNA

General Provider Information

NPI Number	:	1558312140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALPH ALAN LATIMER O.D.

Provider Business Mailing Address
First Line	:	8800 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-5211
Country	:	US
Telephone Number	:	405-684-9448
Fax Number	:	405-684-9447

Provider Business Practice Location Address
First Line	:	8800 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-5211
Country	:	US
Telephone Number	:	405-684-9448
Fax Number	:	405-684-9447

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	11/29/2007

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