Individual
EDDIE STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10948 N MAY AVE, OKLAHOMA CITY, OK 73120-6223
(405) 751-8889
Mailing address
PO BOX 398, NOBLE, OK 73068-0398
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
OK
Enumeration date
01/15/2013
Last updated
01/15/2013
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