Provider Demographics
NPI:1104131622
Name:ELKINS, JAMIE LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LYNN
Last Name:ELKINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:SCOGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7409 S ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7104
Mailing Address - Country:US
Mailing Address - Phone:979-575-3625
Mailing Address - Fax:
Practice Address - Street 1:7409 S ERIE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7104
Practice Address - Country:US
Practice Address - Phone:979-575-3625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7641TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3163172-01Medicaid
TX270985YN7NMedicare PIN