Provider Demographics
NPI:1548204621
Name:EPP, DAVID L (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:EPP
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 1:104 E MAIN ST
Mailing Address - Street 2:PO BOX 278
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662-2914
Mailing Address - Country:US
Mailing Address - Phone:580-928-2212
Mailing Address - Fax:580-928-2303
Practice Address - Street 1:102 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:OK
Practice Address - Zip Code:73662-2914
Practice Address - Country:US
Practice Address - Phone:580-928-2212
Practice Address - Fax:580-928-2303
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2012152W00000X
TX04257T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK73-1440033OtherFED ID #
TX0194193-01Medicaid
OK100767570AMedicaid
OK0308960002Medicare NSC
OKU00894Medicare UPIN
TX0308960001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT
OK73-1440033OtherFED ID #
OK100767570AMedicaid