Basic Information
| Provider Information | |||||||||
| NPI: | 1003440744 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENJIVAR | ||||||||
| FirstName: | BRITTANY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7777 E US HIGHWAY 66 | ||||||||
| Address2: | |||||||||
| City: | EL RENO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730369125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054228829 | ||||||||
| FaxNumber: | 4054228830 | ||||||||
| Practice Location | |||||||||
| Address1: | 7777 E US HIGHWAY 66 | ||||||||
| Address2: | |||||||||
| City: | EL RENO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730369125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054228829 | ||||||||
| FaxNumber: | 4054228830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2020 | ||||||||
| LastUpdateDate: | 03/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156F00000X | OK | Y | Eye and Vision Services Providers | Technician/Technologist |
No ID Information.