Provider Demographics
NPI:1790160455
Name:GIANG, SAMANTHA (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:GIANG
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 1:3857 SOUTHRIDGE CIR
Mailing Address - Street 2:APT #2
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-7948
Mailing Address - Country:US
Mailing Address - Phone:210-421-1438
Mailing Address - Fax:
Practice Address - Street 1:3857 SOUTHRIDGE CIR
Practice Address - Street 2:APT #2
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-7948
Practice Address - Country:US
Practice Address - Phone:210-421-1438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2849152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist