Healthcare Provider Details

I. General information

NPI: 1629184098
Provider Name (Legal Business Name): THEODORE B OKIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: THEODORE B OKIE MD

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 MARTIN LUTHER KING JR BLVD
LYNWOOD CA
90262-2010
US

IV. Provider business mailing address

3510 MARTIN LUTHER KING JR BLVD
LYNWOOD CA
90262-2010
US

V. Phone/Fax

Practice location:
  • Phone: 310-638-9391
  • Fax: 310-603-8749
Mailing address:
  • Phone: 310-638-9391
  • Fax: 310-603-8749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG8937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: