MEDICARE: OKLAHOMA CITY VISION SOURCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2464 TRENT PITT	OK
2	152W00000X	Optometrist	2099 SCOTT FORESTER	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023238755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA CITY VISION SOURCE

Provider Business Mailing Address
First Line	:	3011 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3629
Country	:	US
Telephone Number	:	405-840-2800
Fax Number	:	405-840-8242

Provider Business Practice Location Address
First Line	:	3011 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3629
Country	:	US
Telephone Number	:	405-840-2800
Fax Number	:	405-840-8242

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SCOTT D FORESTER
Credential	:	O.D.
Telephone Number	:	405-840-2800

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	11/19/2009

Similar Medicare Providers

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1316435472 — SHERI BOLAY OM
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1386755148 — MELVYN PREISZ PH.D
Practice Location Address:

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Directions to “OKLAHOMA CITY VISION SOURCE ” Practice Location

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