Provider Demographics
NPI:1013910090
Name:ECONOMOU, ANTHONY (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:ECONOMOU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 E SKELLY DR STE 250
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6233
Mailing Address - Country:US
Mailing Address - Phone:918-317-0022
Mailing Address - Fax:855-327-9828
Practice Address - Street 1:2865 E SKELLY DR STE 250
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6233
Practice Address - Country:US
Practice Address - Phone:918-317-0022
Practice Address - Fax:855-327-9828
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3145207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100137560AMedicaid
OK5533545OtherAETNA
OK1732450OtherUNITED HEALTHCARE
OK1101708OtherFIRST HEALTH
OK100137560AMedicaid
OK1101708OtherFIRST HEALTH