Provider Demographics
NPI:1275501033
Name:MCIVER, ANN L (OD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:L
Last Name:MCIVER
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:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OK
Mailing Address - Zip Code:73448-0267
Mailing Address - Country:US
Mailing Address - Phone:580-276-5548
Mailing Address - Fax:580-276-5541
Practice Address - Street 1:112 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OK
Practice Address - Zip Code:73448-2847
Practice Address - Country:US
Practice Address - Phone:580-276-5548
Practice Address - Fax:580-276-5541
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2139152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100766290AMedicaid
OK100766290AMedicaid
OKU52487Medicare UPIN