Provider Demographics
NPI:1730244302
Name:ATCHLEY, JODY W (OD)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:W
Last Name:ATCHLEY
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 1:2204 N HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1221
Mailing Address - Country:US
Mailing Address - Phone:580-255-9717
Mailing Address - Fax:580-255-7598
Practice Address - Street 1:2204 N HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1221
Practice Address - Country:US
Practice Address - Phone:580-255-9717
Practice Address - Fax:580-255-7598
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2056152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100761730AMedicaid
OK100761730AMedicaid
OKU36432Medicare UPIN