Individual provider Active NPI

Blayke Haggard

  • Optometrist
  • Tahlequah, OK
National Provider Identifier
1548016587
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3262 Issued in OK
Practice address
1001 N Grand Ave
Tahlequah, OK 74464-7017
Phone
(918) 444-4000
NPI assigned
Apr 29, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3262 OK Primary

Addresses

Primary practice location

1001 N Grand Ave
Tahlequah, OK 74464-7017

Mailing address

1001 N Grand Ave
Tahlequah, OK 74464-7017

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, OK2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240822002004 TX Practitioner - Optometry 0143769190 Reassigns benefits to 1 organization
I20240911001031 OK Practitioner - Optometry 0143769190 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cherokee NationGroup PAC ID 5799698742, 446 clinicians

Practice addresses (Care Compare)

27371 S 4410 Rd
Vinita, OK 74301-7953
Phone (918) 256-4800

859 E Melton Dr
Sam Hider Health Center
Jay, OK 74346-0001
Phone (918) 253-4271

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern State University College of Optometry Optometrist CurrentSince Aug 1, 2024 Accepting new patients
Cherokee Nation Current Accepting new patients
Cherokee Nation CurrentSince Aug 1, 2024 Accepting new patients
Cherokee Nation CurrentSince Aug 1, 2024 Accepting new patients
Cherokee Nation Current Accepting new patients

Locations

859 E Melton Dr
Jay, OK 74346
Phone (918) 253-4271

1001 S 41st St E
#3
Muskogee, OK 74403
Phone (918) 687-0201

1020 Lenape Dr
Nowata, OK 74048
Phone (918) 273-0192

900 N Owen Walters Blvd
Salina, OK 74365
Phone (918) 434-8500

870 E Crafton St
Tahlequah, OK 74464
Phone (918) 444-4000

1001 N Grand Ave
Tahlequah, OK 74464
Phone (918) 456-5511

100 S Bliss Ave
Tahlequah, OK 74464
Phone (918) 458-3100

Dept 2269
Tulsa, OK 74182

27371 S 4410 Rd
Vinita, OK 74301
Phone (918) 256-4800

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1548016587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 N GRAND AVE",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744647017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 N GRAND AVE",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744647017",
            "telephone_number": "918-444-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGGARD",
        "first_name": "BLAYKE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-04-29",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "3262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tahlequah, OK

Sources for this page

Verify at the official NPI Registry.