Provider Demographics
NPI:1902865744
Name:HERRIN, CAMERON EUGENE (OD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:EUGENE
Last Name:HERRIN
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 1:1711 N GREEN AVE.
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-4220
Mailing Address - Country:US
Mailing Address - Phone:405-527-2020
Mailing Address - Fax:405-527-0318
Practice Address - Street 1:1711 N GREEN AVE.
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-4220
Practice Address - Country:US
Practice Address - Phone:405-527-2020
Practice Address - Fax:405-527-0318
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2246152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK410042651OtherRAILROAD MEDICARE
OK100764590AMedicaid
OK731546546OtherHEALTHCHOICE
U71105Medicare UPIN
OK1230810001Medicare NSC
OKU71105Medicare PIN
OK731546546OtherHEALTHCHOICE