Provider Demographics
NPI:1023099801
Name:FOX, GARY ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ROBERT
Last Name:FOX
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:10320 S PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE #103
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6916
Mailing Address - Country:US
Mailing Address - Phone:405-691-3937
Mailing Address - Fax:405-691-0312
Practice Address - Street 1:10320 S PENNSYLVANIA AVE
Practice Address - Street 2:SUITE #103
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6916
Practice Address - Country:US
Practice Address - Phone:405-691-3937
Practice Address - Fax:405-691-0312
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK978OtherOKLAHOMA LICENSE NUMBER
OK00978OtherVISION BENEFITS OF AMERIC
OK100764890AMedicaid
OK00978OtherVISION BENEFITS OF AMERIC
OKOKA101625Medicare PIN
OKT40450Medicare UPIN