Provider Demographics
NPI:1336118769
Name:PICKARD, DARRELL J (MD)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:J
Last Name:PICKARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 S DOUGLAS BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5268
Mailing Address - Country:US
Mailing Address - Phone:405-733-4545
Mailing Address - Fax:705-733-2758
Practice Address - Street 1:1455 S DOUGLAS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5268
Practice Address - Country:US
Practice Address - Phone:405-733-4545
Practice Address - Fax:405-733-2758
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18401207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F58885Medicare UPIN
247634802Medicare PIN