Basic Information
| Provider Information | |||||||||
| NPI: | 1093905614 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEDDUM | ||||||||
| FirstName: | TERRI | ||||||||
| MiddleName: | |||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15951 LITTLE AXE DR | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730269088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054470300 | ||||||||
| FaxNumber: | 4057017631 | ||||||||
| Practice Location | |||||||||
| Address1: | 15702 E STATE HIGHWAY 9 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730269001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054470300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2007 | ||||||||
| LastUpdateDate: | 06/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2543 | OK | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 2700 | CO | N | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 2543 | 01 | OK | STATE LICENSE NUMBER | OTHER | 800522350 | 01 | OK | MEDICARE GROUP | OTHER | 200116210A | 05 | OK | MEDICAID | 2700 | 01 | CO | STATE LICENSE NUMBER | OTHER |