Provider Demographics
NPI:1396965075
Name:VALERIE R HATLEY PC
Entity type:Organization
Organization Name:VALERIE R HATLEY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:RIDGENA
Authorized Official - Last Name:HATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-354-2788
Mailing Address - Street 1:621 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-1035
Mailing Address - Country:US
Mailing Address - Phone:405-354-2788
Mailing Address - Fax:
Practice Address - Street 1:621 W MAIN ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-1035
Practice Address - Country:US
Practice Address - Phone:405-354-2788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK224152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU71869Medicare UPIN