MEDICARE: DR. JAMES ALLEN WARD 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	2113	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

General Provider Information

NPI Number	:	1578579819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ALLEN WARD O.D.

Provider Business Mailing Address
First Line	:	PO BOX 520
Second Line	:	300 CREEK PLACE
City	:	OKMULGEE
State	:	OK
Zip	:	74447-0520
Country	:	US
Telephone Number	:	918-756-0316
Fax Number	:	918-756-2022

Provider Business Practice Location Address
First Line	:	300 CREEK PL
Second Line	:
City	:	OKMULGEE
State	:	OK
Zip	:	74447-6730
Country	:	US
Telephone Number	:	918-756-0316
Fax Number	:	918-756-2022

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	11/29/2010

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