Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2762 | OK |
NPI | 1013263326 |
---|---|
Provider Name | Dr. Kathleen Yang |
First Address | Midwest City, OK 73110-7530 |
Second Address | Midwest City, OK 73110-7530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2012 |
Last Update Date | 14/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
297660YTKN | (02) | OK |