Provider Demographics
NPI:1366449225
Name:HIGGS, LARRY WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WAYNE
Last Name:HIGGS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-4312
Mailing Address - Country:US
Mailing Address - Phone:918-224-2610
Mailing Address - Fax:918-224-0613
Practice Address - Street 1:17 S OAK ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4312
Practice Address - Country:US
Practice Address - Phone:918-224-2610
Practice Address - Fax:918-224-0613
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0229152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100763080AMedicaid
OKT40498Medicare UPIN