Provider Demographics
NPI:1144759515
Name:PRESTRIDGE, MONIQUE (OCULARIST)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:PRESTRIDGE
Suffix:
Gender:F
Credentials:OCULARIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4845
Mailing Address - Country:US
Mailing Address - Phone:405-757-9446
Mailing Address - Fax:
Practice Address - Street 1:4409 N MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73112-2401
Practice Address - Country:US
Practice Address - Phone:405-831-4373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2023-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist