Provider Demographics
NPI:1255773594
Name:CISPER, LAUREN RACHELLE (OD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:RACHELLE
Last Name:CISPER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:RACHELLE
Other - Last Name:FROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30725 S POWERS LN
Mailing Address - Street 2:
Mailing Address - City:INOLA
Mailing Address - State:OK
Mailing Address - Zip Code:74036-3057
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 S FLORENCE AVE
Practice Address - Street 2:150
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-7262
Practice Address - Country:US
Practice Address - Phone:918-341-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist