Provider Demographics
NPI:1134857279
Name:TUCKER, MEGAN RAE (OD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:RAE
Last Name:TUCKER
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 1:3730 E MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-6928
Mailing Address - Country:US
Mailing Address - Phone:918-886-0312
Mailing Address - Fax:
Practice Address - Street 1:1200 S AIR DEPOT BLVD STE A
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4848
Practice Address - Country:US
Practice Address - Phone:405-494-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3205152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist