Provider Demographics
NPI:1912099029
Name:SCHELLENBERG, TASHA JOHNNETTE (OD)
Entity Type:Individual
Prefix:DR
First Name:TASHA
Middle Name:JOHNNETTE
Last Name:SCHELLENBERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3500 NW 56TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4529
Mailing Address - Country:US
Mailing Address - Phone:405-271-9500
Mailing Address - Fax:405-271-9505
Practice Address - Street 1:3500 NW 56TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4529
Practice Address - Country:US
Practice Address - Phone:405-271-9500
Practice Address - Fax:405-271-9505
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200331540AMedicaid
OK200331540AMedicaid
OKOKAAA2246Medicare PIN