Provider Demographics
NPI:1811305659
Name:TEBOW, MOLLY GEAN (OD)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:GEAN
Last Name:TEBOW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:681 W CHOCTAW ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3711
Mailing Address - Country:US
Mailing Address - Phone:918-456-2250
Mailing Address - Fax:918-456-2251
Practice Address - Street 1:681 W CHOCTAW ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3711
Practice Address - Country:US
Practice Address - Phone:918-456-2250
Practice Address - Fax:918-456-2251
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2831152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist