MEDICARE: DAVID EPP OD PC

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

General Provider Information

NPI Number	:	1902028277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID EPP OD PC

Provider Business Mailing Address
First Line	:	PO BOX 278
Second Line	:
City	:	SAYRE
State	:	OK
Zip	:	73662-0278
Country	:	US
Telephone Number	:	580-928-2212
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 E MAIN ST
Second Line	:
City	:	SAYRE
State	:	OK
Zip	:	73662-2914
Country	:	US
Telephone Number	:	580-928-2212
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. DAVID LAVERNE EPP
Credential	:	D O
Telephone Number	:	580-928-2212

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	06/06/2008

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