Provider Demographics
NPI:1457458366
Name:PIPER-HUGHBANKS, TRINA D
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:D
Last Name:PIPER-HUGHBANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 4TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-2363
Mailing Address - Country:US
Mailing Address - Phone:058-032-7333
Mailing Address - Fax:580-327-3337
Practice Address - Street 1:410 4TH ST STE D
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-2363
Practice Address - Country:US
Practice Address - Phone:580-327-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100761710AMedicaid
OKOKA103780OtherMEDICARE GROUP PTAN
OK100761710AMedicaid
OKOKA103780OtherMEDICARE GROUP PTAN