Provider Demographics
NPI:1386750180
Name:EVANS, KARL DEAN JR (OD)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:DEAN
Last Name:EVANS
Suffix:JR
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 1:113 N HIGHWAY 18
Mailing Address - Street 2:PO BOX 68
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-1200
Mailing Address - Country:US
Mailing Address - Phone:405-258-1234
Mailing Address - Fax:
Practice Address - Street 1:113 N HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-1200
Practice Address - Country:US
Practice Address - Phone:405-258-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1175152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100762700AMedicaid
OKT40435Medicare UPIN
OK100762700AMedicaid
OK410049799Medicare PIN
OK24J625701Medicare PIN