Individual
DR. LACY NICOLE CRISSUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
212 E BLUE STARR DR, CLAREMORE, OK 74017-4223
(918) 341-8211
(918) 341-8233
Mailing address
212 E BLUE STARR DR, CLAREMORE, OK 74017-4223
(918) 341-8211
(918) 341-8233
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2600
OK
Other
Enumeration date
07/23/2009
Last updated
07/23/2009
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