MEDICARE: LILLIAN MCENTIRE

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	3180	OK

General Provider Information

NPI Number	:	1659006872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN MCENTIRE

Provider Business Mailing Address
First Line	:	2225 SE WASHINGTON BLVD
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-7136
Country	:	US
Telephone Number	:	918-333-9292
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 SE WASHINGTON BLVD
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-7136
Country	:	US
Telephone Number	:	918-333-9292
Fax Number	:

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

Provider Enumeration Date	:	07/21/2022
Last Update Date	:	01/25/2024

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Directions to “ LILLIAN MCENTIRE ” Practice Location

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