Provider Demographics
NPI:1619039518
Name:MEGOWN, WALTER PRESLEY (OD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:PRESLEY
Last Name:MEGOWN
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:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-0610
Mailing Address - Country:US
Mailing Address - Phone:918-756-2124
Mailing Address - Fax:918-756-3865
Practice Address - Street 1:916 E 8TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-4724
Practice Address - Country:US
Practice Address - Phone:918-756-2124
Practice Address - Fax:918-756-3865
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK880152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK410038339OtherRAILROAD MEDICARE PTAN
OK100761970AMedicaid
730950703001OtherBC/BS
OK410038339OtherRAILROAD MEDICARE PTAN
730950703001OtherBC/BS
T40561Medicare UPIN
OK100761970AMedicaid