Provider Demographics
NPI:1346387289
Name:COLE, ELIZABETH JEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JEAN
Last Name:COLE
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 1:1911 N COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1382
Mailing Address - Country:US
Mailing Address - Phone:580-223-0055
Mailing Address - Fax:580-223-0776
Practice Address - Street 1:1911 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1382
Practice Address - Country:US
Practice Address - Phone:580-223-0055
Practice Address - Fax:580-223-0776
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2418152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKV03994Medicare UPIN