Provider Demographics
NPI:1710153127
Name:DR. JODY W. ATCHLEY, OPTOMETRIST
Entity Type:Organization
Organization Name:DR. JODY W. ATCHLEY, OPTOMETRIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:W
Authorized Official - Last Name:ATCHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-255-9717
Mailing Address - Street 1:2204 1/2 N HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1221
Mailing Address - Country:US
Mailing Address - Phone:580-255-9717
Mailing Address - Fax:580-255-7598
Practice Address - Street 1:2204 1/2 N HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1221
Practice Address - Country:US
Practice Address - Phone:580-255-9717
Practice Address - Fax:580-255-7598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2056152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK761730AMedicaid
OK761730AMedicaid
0658000001Medicare NSC