Provider Demographics
NPI:1891978748
Name:HUMPHREY, COURTNEY KENSING (OD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:KENSING
Last Name:HUMPHREY
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 1:2624 SE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-6730
Mailing Address - Country:US
Mailing Address - Phone:405-850-4864
Mailing Address - Fax:
Practice Address - Street 1:2624 SE 8TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-6730
Practice Address - Country:US
Practice Address - Phone:405-850-4864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6797152W00000X
OK2456152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist