Provider Demographics
NPI:1881696177
Name:LAYTON, ANTHONY W
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:W
Last Name:LAYTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21225000000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0254840001Medicare PIN
OK0254840001Medicare NSC