Provider Demographics
NPI:1932416930
Name:ACORD, CANDACE (ODL)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:ACORD
Suffix:
Gender:F
Credentials:ODL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 N HARRAH RD
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-9692
Mailing Address - Country:US
Mailing Address - Phone:405-454-0099
Mailing Address - Fax:
Practice Address - Street 1:123 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:OK
Practice Address - Zip Code:74873-3241
Practice Address - Country:US
Practice Address - Phone:405-598-6558
Practice Address - Fax:405-598-2202
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-12
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist