MEDICARE: CANDACE ACORD O.D.L

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	2635	OK

General Provider Information

NPI Number	:	1932416930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE ACORD O.D.L

Provider Business Mailing Address
First Line	:	1087 N HARRAH RD
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-9692
Country	:	US
Telephone Number	:	405-454-0099
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 E WASHINGTON ST
Second Line	:
City	:	TECUMSEH
State	:	OK
Zip	:	74873-3241
Country	:	US
Telephone Number	:	405-598-6558
Fax Number	:	405-598-2202

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

Provider Enumeration Date	:	09/12/2010
Last Update Date	:	06/18/2018

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