Provider Demographics
NPI:1821077579
Name:JACKSON, TONYA WARD (OD)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:WARD
Last Name:JACKSON
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 1:7114 S MINGO RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3241
Mailing Address - Country:US
Mailing Address - Phone:918-285-7432
Mailing Address - Fax:918-250-9003
Practice Address - Street 1:7114 S MINGO RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3241
Practice Address - Country:US
Practice Address - Phone:918-285-7432
Practice Address - Fax:918-250-9003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1196152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist