Provider Demographics
NPI:1124201843
Name:REGGEL OAKES, SALLY LUE (MD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:LUE
Last Name:REGGEL OAKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1852 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-5301
Mailing Address - Country:US
Mailing Address - Phone:304-522-7225
Mailing Address - Fax:
Practice Address - Street 1:1852 MILITARY RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-5301
Practice Address - Country:US
Practice Address - Phone:304-522-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09723156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic