Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2576 | OK |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2576 | OK |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 2576 | OK |
N | 152WP0200X | Pediatric Optomitrist | 2576 | OK |
N | 152WS0006X | Sports Vision | 2576 | OK |
N | 152WV0400X | Optomitrist - Vision Therapist | 2576 | OK |
N | 152WX0102X | Occupational Vision | 2576 | OK |
NPI | 1013173715 |
---|---|
Provider Name | Martin Dee O'donnell |
First Address | Holdenville, OK 74848-0897 |
Second Address | Holdenville, OK 74848-3229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2008 |
Last Update Date | 11/08/2014 |