Provider Demographics
NPI:1437279924
Name:STURM, MARY JOEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JOEL
Last Name:STURM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:JOEL
Other - Last Name:STURM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:224 S GATEWAY PL JENKS OK
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3453
Mailing Address - Country:US
Mailing Address - Phone:918-747-2020
Mailing Address - Fax:918-747-2056
Practice Address - Street 1:224 S GATEWAY PL
Practice Address - Street 2:SUITE 101
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3460
Practice Address - Country:US
Practice Address - Phone:918-747-2020
Practice Address - Fax:918-747-2056
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2142152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist