Individual
DR. GARY JAY LAVALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
900 W MAIN ST, HENRYETTA, OK 74437-4252
(918) 652-2345
(918) 652-2537
Mailing address
900 W MAIN ST, HENRYETTA, OK 74437-4252
(918) 652-2345
(918) 652-2537
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2071
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100764630A
—
OK
01
—
410003624
RAIL ROAD MEDICARE
OK
01
—
P00626582
RAILROAD MEDICARE
OK
Enumeration date
06/12/2006
Last updated
09/13/2012
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