Provider Demographics
NPI:1275294035
Name:TIBBETTS, LEAH K
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:K
Last Name:TIBBETTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5312 W 41ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-6110
Mailing Address - Country:US
Mailing Address - Phone:918-800-2020
Mailing Address - Fax:877-464-4002
Practice Address - Street 1:809 N 3RD ST STE 100
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6702
Practice Address - Country:US
Practice Address - Phone:918-800-2020
Practice Address - Fax:877-464-4002
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty