Healthcare Provider Details

I. General information

NPI: 1811256811
Provider Name (Legal Business Name): ARDMORE VISION & LASER EYE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 WALNUT DR
ARDMORE OK
73401-2353
US

IV. Provider business mailing address

1702 N COMMERCE ST STE A
ARDMORE OK
73401-1500
US

V. Phone/Fax

Practice location:
  • Phone: 580-223-5300
  • Fax: 580-223-5356
Mailing address:
  • Phone: 580-223-5300
  • Fax: 580-223-5356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. DENVER C RUSHING
Title or Position: OWNER
Credential: O.D.
Phone: 580-223-5300