Provider Demographics
NPI:1902028277
Name:DAVID EPP OD PC
Entity Type:Organization
Organization Name:DAVID EPP OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAVERNE
Authorized Official - Last Name:EPP
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:580-928-2212
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662-0278
Mailing Address - Country:US
Mailing Address - Phone:580-928-2212
Mailing Address - Fax:
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:OK
Practice Address - Zip Code:73662-2914
Practice Address - Country:US
Practice Address - Phone:580-928-2212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2012152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0308960002Medicare NSC