Provider Demographics
NPI:1881602407
Name:RICE, SHELLY DEANN (OD)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:DEANN
Last Name:RICE
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 E CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-4710
Mailing Address - Country:US
Mailing Address - Phone:918-485-4775
Mailing Address - Fax:918-485-7611
Practice Address - Street 1:512 E CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-4710
Practice Address - Country:US
Practice Address - Phone:918-485-4775
Practice Address - Fax:918-485-7611
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100761650BMedicaid
OK$$$$$$$$$Medicare PIN
OKU75511Medicare UPIN