| |
4205 Mcauley Blvd, Oklahoma City, OK 73120-8347 | |
(405) 755-6111 | |
(405) 755-6298 |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 4205 Mcauley Blvd, Oklahoma City, Oklahoma |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1588652705 | NPI | - | NPPES |
100745180A | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
207W00000X | Ophthalmology | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | 19601 (Oklahoma) | Primary |
Mailing Address | Practice Location Address |
---|---|
4205 Mcauley Blvd Ste 401, Oklahoma City, OK 73120-8347 Ph: (405) 755-6111 | 4205 Mcauley Blvd, Oklahoma City, OK 73120-8347 Ph: (405) 755-6111 |