Provider Demographics
NPI:1770576530
Name:BRASSFIELD, LETITIA ANJANETTE (OD)
Entity type:Individual
Prefix:
First Name:LETITIA
Middle Name:ANJANETTE
Last Name:BRASSFIELD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LETITIA
Other - Middle Name:ANJI
Other - Last Name:BRASSFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10920 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7352
Mailing Address - Country:US
Mailing Address - Phone:918-366-2020
Mailing Address - Fax:918-794-2720
Practice Address - Street 1:10920 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7352
Practice Address - Country:US
Practice Address - Phone:918-366-2020
Practice Address - Fax:918-794-2720
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2030152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU19206Medicare UPIN