Provider Demographics
NPI:1851321475
Name:LAYTON, HARRY (CPO, LPO)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:LAYTON
Suffix:
Gender:M
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6319
Mailing Address - Country:US
Mailing Address - Phone:580-353-5525
Mailing Address - Fax:580-353-5523
Practice Address - Street 1:2724 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6319
Practice Address - Country:US
Practice Address - Phone:580-353-5525
Practice Address - Fax:580-353-5523
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPO46222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0611790001Medicare NSC