Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1144759515 |
---|---|
Provider Name | Monique Prestridge |
First Address | Edmond, OK 73034-4845 |
Second Address | Oklahoma City, OK 73102-2619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2017 |
Last Update Date | 17/03/2018 |