Provider Demographics
NPI:1649558321
Name:CONKLIN, TREVOR C (OD)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:C
Last Name:CONKLIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10012 S DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2947
Mailing Address - Country:US
Mailing Address - Phone:405-308-3430
Mailing Address - Fax:
Practice Address - Street 1:10101 S PENN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6929
Practice Address - Country:US
Practice Address - Phone:405-691-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2690152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist