Provider Demographics
NPI:1871229583
Name:WINGFIELD, JARRETT L (OD)
Entity type:Individual
Prefix:DR
First Name:JARRETT
Middle Name:L
Last Name:WINGFIELD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5312 W 41ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-6110
Mailing Address - Country:US
Mailing Address - Phone:918-800-2020
Mailing Address - Fax:877-464-4002
Practice Address - Street 1:7472 E ADMIRAL PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74115-7913
Practice Address - Country:US
Practice Address - Phone:918-836-2020
Practice Address - Fax:866-834-4717
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3208152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3208OtherBOARD OF EXAMINERS IN OPTOMETRY STATE OF OKLAHOMA