Provider Demographics
NPI:1558378794
Name:ELLIOTT, KATHLEEN F (OD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:F
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:SPURGEON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:9306 S TOLEDO CT STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2746
Mailing Address - Country:US
Mailing Address - Phone:918-388-3949
Mailing Address - Fax:918-388-0843
Practice Address - Street 1:9306 S TOLEDO CT STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2746
Practice Address - Country:US
Practice Address - Phone:918-388-3949
Practice Address - Fax:918-388-0843
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100763310BMedicaid
OK6157730001Medicare NSC
OKOK700135Medicare PIN
OK100763310BMedicaid