Provider Demographics
NPI:1548278112
Name:RIGNEY, JAN JAY (OD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:JAY
Last Name:RIGNEY
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 1:11880 E 86TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2535
Mailing Address - Country:US
Mailing Address - Phone:918-272-3937
Mailing Address - Fax:918-272-4251
Practice Address - Street 1:11880 E 86TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2535
Practice Address - Country:US
Practice Address - Phone:918-272-3937
Practice Address - Fax:918-272-4251
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK1093152WP0200X
OK1093152WC0802X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKT40620Medicare UPIN