Provider Demographics
NPI:1710289640
Name:ELDRIDGE, DAVID CRAIG (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CRAIG
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6603 E 112TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-2059
Mailing Address - Country:US
Mailing Address - Phone:918-299-7443
Mailing Address - Fax:918-398-9770
Practice Address - Street 1:6603 E 112TH ST S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2059
Practice Address - Country:US
Practice Address - Phone:918-299-7443
Practice Address - Fax:918-398-9770
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0941152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist