Organization
MERCER BEAUTY SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. IVA L BLACK (OWNER)
(580) 353-0690
Entity
Organization
Contact information
Practice address
1016 SW D AVE, LAWTON, OK 73501
(580) 353-0690
Mailing address
1016 SW D AVE, LAWTON, OK 73501
(580) 353-0690
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
22498 001
OK
335E00000X
Prosthetic/Orthotic Supplier
Primary
22498 001
OK
Other
Enumeration date
09/11/2007
Last updated
07/16/2008
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