Provider Demographics
NPI:1831371038
Name:ANTHONY W. LAYTON
Entity type:Organization
Organization Name:ANTHONY W. LAYTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:W
Authorized Official - Last Name:LAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:580-353-8885
Mailing Address - Street 1:15 SW B AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-4006
Mailing Address - Country:US
Mailing Address - Phone:580-353-8885
Mailing Address - Fax:580-353-2426
Practice Address - Street 1:15 SW B AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4006
Practice Address - Country:US
Practice Address - Phone:580-353-8885
Practice Address - Fax:580-353-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0254840001Medicare PIN
0254840001Medicare NSC