Provider Demographics
NPI:1568071207
Name:GRIFFIN, NIGENDA (OD)
Entity Type:Individual
Prefix:
First Name:NIGENDA
Middle Name:
Last Name:GRIFFIN
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:PO BOX 1726
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-1726
Mailing Address - Country:US
Mailing Address - Phone:580-225-1555
Mailing Address - Fax:580-225-1558
Practice Address - Street 1:350 E INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1119
Practice Address - Country:US
Practice Address - Phone:177-545-9118
Practice Address - Fax:303-800-2078
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3072152W00000X
TX10825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist