Provider Demographics
NPI:1144874405
Name:WIGGINS, JEREMY A (OD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:A
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:901 SW GOODYEAR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9755
Mailing Address - Country:US
Mailing Address - Phone:580-531-5790
Mailing Address - Fax:580-248-0074
Practice Address - Street 1:901 SW GOODYEAR BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9755
Practice Address - Country:US
Practice Address - Phone:580-531-5790
Practice Address - Fax:580-510-6307
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist