Provider Demographics
NPI:1306234067
Name:TIPTON, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TIPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4032
Mailing Address - Country:US
Mailing Address - Phone:405-372-3370
Mailing Address - Fax:405-372-3389
Practice Address - Street 1:103 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4032
Practice Address - Country:US
Practice Address - Phone:405-372-3370
Practice Address - Fax:405-372-3389
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician