Provider Demographics
NPI:1851646178
Name:POE, JONATHAN (OD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:POE
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 1:2008 S POST RD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-6610
Mailing Address - Country:US
Mailing Address - Phone:405-732-2277
Mailing Address - Fax:
Practice Address - Street 1:2008 S POST RD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-6610
Practice Address - Country:US
Practice Address - Phone:405-732-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2747152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist