Basic Information
| Provider Information | |||||||||
| NPI: | 1316103401 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAYES | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1511 CREEKSIDE DR | ||||||||
| Address2: | |||||||||
| City: | TAHLEQUAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744646239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058800352 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4520 S HARVARD AVE | ||||||||
| Address2: | SUITE 135 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741352925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187459662 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2008 | ||||||||
| LastUpdateDate: | 08/25/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2570 | OK | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.