Pack, Latricia
Pack, Latricia is an individual health care provider with primary practice located at 1001 N Grand Ave , Tahlequah OK 74464-7017. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Pack, Latricia can be contacted via phone (918) 458-2109.Contact Information
Primary practice address
1001 N Grand Ave
Tahlequah OK 74464-7017
Phone: (918) 458-2109
Fax: (918) 458-2310
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2257 | Oklahoma |
Profile Details
| NPI number | 1043230477 |
|---|---|
| LBN Legal business name | Pack, Latricia |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 20th, 2006 |
| Last updated | Jul 31st, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043230477 | NPPES |
| Oklahoma | MEDICAID | 100765190A |
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