Individual
LAURIE ANN REAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
401 S MADISON ST, KONAWA, OK 74849-2631
(580) 933-6597
Mailing address
1300 S MEKUSUKEY AVE, WEWOKA, OK 74884-3643
(580) 933-6597
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Enumeration date
11/08/2011
Last updated
11/08/2011
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