Provider Demographics
NPI:1992051148
Name:STOTTS, HEATH DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:HEATH
Middle Name:DAVID
Last Name:STOTTS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 W OWEN K GARRIOTT RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5523
Mailing Address - Country:US
Mailing Address - Phone:580-233-3599
Mailing Address - Fax:580-237-2560
Practice Address - Street 1:502 W OWEN K GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5523
Practice Address - Country:US
Practice Address - Phone:580-233-3599
Practice Address - Fax:580-237-2560
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200465100AMedicaid
OK200465100AMedicaid
OK6726730001Medicare NSC