Doctor Name: | LAURIE ANN REAL |
NPI Number: | 1447537287 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 401 S Madison St Konawa, OK - 748492631 |
Business Phone Number: | 5809336597 |
Business Fax Number: | |
Mailing Address: | 1300 S Mekusukey Ave, WEWOKA |
State: | OK |
Postal Code: | 748843643 |
Phone Number: | 5809336597 |
Fax Number: | |
NPI Enumeration Date: | 11/08/2011 |
NPI Last Update Date: | 11/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |