Provider Demographics
NPI:1518974641
Name:GITTINS, TRAVIS G (OD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:G
Last Name:GITTINS
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 1:8812 N COUNCIL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3246
Mailing Address - Country:US
Mailing Address - Phone:405-773-3937
Mailing Address - Fax:405-728-3939
Practice Address - Street 1:8812 N COUNCIL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-3246
Practice Address - Country:US
Practice Address - Phone:405-773-3937
Practice Address - Fax:405-728-3939
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2242152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100767750AMedicaid
OK429430394002OtherBCBS
OK100767750AMedicaid