Provider Demographics
NPI:1073564092
Name:RAY, SOMER AUSTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:SOMER
Middle Name:AUSTIN
Last Name:RAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 EL CAMINO ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-2715
Mailing Address - Country:US
Mailing Address - Phone:918-671-3821
Mailing Address - Fax:
Practice Address - Street 1:2109 EL CAMINO ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-2715
Practice Address - Country:US
Practice Address - Phone:918-671-3821
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2467152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist