Healthcare Provider Details

I. General information

NPI: 1851912687
Provider Name (Legal Business Name): SUCCESS VISION EXPRESS OF PADUCAH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 JORDAN DR SUITE 102
PADUCAH KY
42001
US

IV. Provider business mailing address

5312 W 41ST ST
TULSA OK
74107-6110
US

V. Phone/Fax

Practice location:
  • Phone: 270-770-2020
  • Fax: 270-770-2020
Mailing address:
  • Phone: 918-895-1700
  • Fax: 877-464-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: CAMERON PICKENS
Title or Position: INSURANCE OPERATIONS MANAGER
Credential:
Phone: 918-895-1700