Provider Demographics
NPI:1558312140
Name:LATIMER, RALPH ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:ALAN
Last Name:LATIMER
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 1:8800 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-5211
Mailing Address - Country:US
Mailing Address - Phone:405-684-9448
Mailing Address - Fax:405-684-9447
Practice Address - Street 1:8800 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-5211
Practice Address - Country:US
Practice Address - Phone:405-684-9448
Practice Address - Fax:405-684-9447
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2307152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7061187OtherAETNA
U82393Medicare UPIN