Provider Demographics
NPI:1548829567
Name:GLOVER, DEVYN ALEXANDRIA (OD)
Entity type:Individual
Prefix:
First Name:DEVYN
Middle Name:ALEXANDRIA
Last Name:GLOVER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DEVYN
Other - Middle Name:ALEXANDRIA
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5600 N PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2023
Mailing Address - Country:US
Mailing Address - Phone:405-943-4413
Mailing Address - Fax:405-942-0115
Practice Address - Street 1:5600 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2023
Practice Address - Country:US
Practice Address - Phone:405-943-4413
Practice Address - Fax:405-942-0115
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003493152W00000X, 152W00000X
OK3042152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist