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NPI Code Detail

MEDICARE: KATIE DOAN TIENABESO OD

MEDICARE: KATIE DOAN TIENABESO 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
1152WP0200XPediatric Optometrist3259OK
2152WV0400XVision Therapy Optometrist3259OK
3152W00000XOptometrist3259OK

General Provider Information

NPI Number : 1841038676
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE DOAN TIENABESO OD
Provider Business Mailing Address
First Line : 1 NE 2ND ST APT 404
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73104-2236
Country : US
Telephone Number : 405-625-7999
Fax Number :
Provider Business Practice Location Address
First Line : 2800 NW 36TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-7477
Country : US
Telephone Number : 405-943-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2024
Last Update Date : 08/19/2024

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Directions to “ KATIE DOAN TIENABESO OD” Practice Location

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