Provider Demographics
NPI:1396746384
Name:REGE DRAVID, VIDYA (MD)
Entity type:Individual
Prefix:MRS
First Name:VIDYA
Middle Name:
Last Name:REGE DRAVID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 S COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-4907
Mailing Address - Country:US
Mailing Address - Phone:405-262-9900
Mailing Address - Fax:405-262-9949
Practice Address - Street 1:927 S COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-4907
Practice Address - Country:US
Practice Address - Phone:405-262-9900
Practice Address - Fax:405-262-9949
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11132207W00000X
OKOK11132174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100021390BMedicaid
OK100021390BMedicaid
C95394Medicare UPIN