Provider Demographics
NPI:1518002534
Name:ROCKETT, STACEY REBECCA (OD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:REBECCA
Last Name:ROCKETT
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 1:7519 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3203
Mailing Address - Country:US
Mailing Address - Phone:405-286-2220
Mailing Address - Fax:405-286-0317
Practice Address - Street 1:7519 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3203
Practice Address - Country:US
Practice Address - Phone:405-286-2220
Practice Address - Fax:405-286-0317
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2286152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKA105639Medicare PIN
OKU76370Medicare UPIN