Provider Demographics
NPI:1497894844
Name:PETTIGREW, JEFFREY LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LYNN
Last Name:PETTIGREW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2501 BOARDWALK
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6372
Mailing Address - Country:US
Mailing Address - Phone:405-321-2155
Mailing Address - Fax:405-321-1170
Practice Address - Street 1:114 36TH AVE NW
Practice Address - Street 2:SUITE 120
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4812
Practice Address - Country:US
Practice Address - Phone:405-366-1110
Practice Address - Fax:405-360-5749
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2176152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist