Provider Demographics
NPI:1710705975
Name:LARIMORE, MALLORIE BETH (OD)
Entity type:Individual
Prefix:
First Name:MALLORIE
Middle Name:BETH
Last Name:LARIMORE
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:MALLORIE
Other - Middle Name:
Other - Last Name:LYNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1601 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5655
Mailing Address - Country:US
Mailing Address - Phone:405-509-4913
Mailing Address - Fax:
Practice Address - Street 1:8215 S MINGO RD STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4671
Practice Address - Country:US
Practice Address - Phone:918-252-7432
Practice Address - Fax:918-250-9003
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3268152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist