MEDICARE: HERO VISION OF OKC PLLC

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

General Provider Information

NPI Number	:	1952948614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERO VISION OF OKC PLLC

Provider Business Mailing Address
First Line	:	2221 E BIJOU ST STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-8009
Country	:	US
Telephone Number	:	719-576-1850
Fax Number	:

Provider Business Practice Location Address
First Line	:	4836 NW 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-1809
Country	:	US
Telephone Number	:	719-576-1850
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	SHAUN URBANOZO
Credential	:
Telephone Number	:	719-576-1850

Provider Enumeration Date	:	12/02/2019
Last Update Date	:	12/02/2019

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