Provider Demographics
NPI:1326028838
Name:HATLEY, VALERIE RIDGENA (OD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:RIDGENA
Last Name:HATLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:RIDGENA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:621 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-1035
Mailing Address - Country:US
Mailing Address - Phone:405-354-2788
Mailing Address - Fax:
Practice Address - Street 1:621 W MAIN ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-1035
Practice Address - Country:US
Practice Address - Phone:405-354-2788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK2245152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU71869Medicare UPIN