Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 790 | OK |
NPI | 1013008101 |
---|---|
Provider Name | Dr. J C Trotter |
First Address | Ponca City, OK 74601-2004 |
Second Address | Ponca City, OK 74601-2004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T40689 | (02) | OK |