Provider Demographics
NPI:1982181855
Name:PARTIN, TRAVIS (OD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:PARTIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 N BITTERCREEK TER
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-9430
Mailing Address - Country:US
Mailing Address - Phone:405-620-5668
Mailing Address - Fax:
Practice Address - Street 1:10010 E 81ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4556
Practice Address - Country:US
Practice Address - Phone:405-620-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3002152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist