Provider Demographics
NPI:1770632044
Name:RIGGINS, LAURA KATHRYN (OD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KATHRYN
Last Name:RIGGINS
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 1:401 N MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-7555
Mailing Address - Country:US
Mailing Address - Phone:918-245-9546
Mailing Address - Fax:
Practice Address - Street 1:401 N MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7555
Practice Address - Country:US
Practice Address - Phone:918-245-9546
Practice Address - Fax:918-245-9547
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2285152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100763840AMedicaid
U75502Medicare UPIN
OK100763840AMedicaid