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Individual

DR. REBECCA LYNN POAGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OD

Contact information

Practice address
500 N FINANCIAL TER, SUITE A, MUSTANG, OK 73064-4432
(405) 256-0126
(405) 256-0563
Mailing address
1432 N MUSTANG RD STE A, MUSTANG, OK 73064-7214
(405) 256-0126
(405) 256-0563

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2430
OK
152WC0802X
Corneal and Contact Management Optometrist
2430
OK
152WL0500X
Low Vision Rehabilitation Optometrist
2430
OK
152WP0200X
Pediatric Optometrist
2430
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200063870A
OK
05
200064830A
OK
01
OKB5562
MEDICARE GROUP PTAN
OK
Enumeration date
01/18/2006
Last updated
06/12/2024
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