Provider Demographics
NPI:1093905614
Name:STEDDUM, TERRI (OD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:STEDDUM
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 1:15951 LITTLE AXE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73026-9088
Mailing Address - Country:US
Mailing Address - Phone:405-447-0300
Mailing Address - Fax:405-701-7631
Practice Address - Street 1:15702 E STATE HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73026-9001
Practice Address - Country:US
Practice Address - Phone:405-447-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2543152W00000X
CO2700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2543OtherSTATE LICENSE NUMBER
OK800522350OtherMEDICARE GROUP
OK200116210AMedicaid
CO2700OtherSTATE LICENSE NUMBER
OK246735505Medicare PIN