Provider Demographics
NPI:1679240709
Name:PANTOJA, JOANA CECILIA (OD)
Entity Type:Individual
Prefix:MISS
First Name:JOANA
Middle Name:CECILIA
Last Name:PANTOJA
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 1:14000 QUAILBROOK DR.
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134
Mailing Address - Country:US
Mailing Address - Phone:405-751-7727
Mailing Address - Fax:405-755-1875
Practice Address - Street 1:14000 QUAILBROOK DR.
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134
Practice Address - Country:US
Practice Address - Phone:405-751-7727
Practice Address - Fax:405-755-1875
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3144152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist