Provider Demographics
NPI:1578579819
Name:WARD, JAMES ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALLEN
Last Name:WARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:300 CREEK PLACE
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-0520
Mailing Address - Country:US
Mailing Address - Phone:918-756-0316
Mailing Address - Fax:918-756-2022
Practice Address - Street 1:300 CREEK PL
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6730
Practice Address - Country:US
Practice Address - Phone:918-756-0316
Practice Address - Fax:918-756-2022
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2113152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100762200AMedicaid
OKU43338Medicare UPIN