Provider Demographics
NPI:1619586336
Name:NELSON, ARIKA LYNNE
Entity Type:Individual
Prefix:
First Name:ARIKA
Middle Name:LYNNE
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 S LAUREL PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-4541
Mailing Address - Country:US
Mailing Address - Phone:918-312-1685
Mailing Address - Fax:
Practice Address - Street 1:13404 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-3104
Practice Address - Country:US
Practice Address - Phone:918-369-2020
Practice Address - Fax:918-369-8600
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist