Provider Demographics
NPI:1578682647
Name:DRS HIGGS & MORRIS OPTOMETRISTS INC
Entity Type:Organization
Organization Name:DRS HIGGS & MORRIS OPTOMETRISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-224-2610
Mailing Address - Street 1:17 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-4312
Mailing Address - Country:US
Mailing Address - Phone:918-224-2610
Mailing Address - Fax:918-224-0613
Practice Address - Street 1:17 S OAK ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4312
Practice Address - Country:US
Practice Address - Phone:918-224-2610
Practice Address - Fax:918-224-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK844152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100763080AMedicaid
OKOKB5565OtherPTAN
OK100763080AMedicaid