Healthcare Provider Details

I. General information

NPI: 1689890840
Provider Name (Legal Business Name): CATHERINE F CARLIN O D,P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 NW 23RD ST
BETHANY OK
73008-5931
US

IV. Provider business mailing address

6303 NW 23RD ST
BETHANY OK
73008-5931
US

V. Phone/Fax

Practice location:
  • Phone: 405-782-0301
  • Fax: 405-782-0302
Mailing address:
  • Phone: 405-782-0301
  • Fax: 405-782-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number2093
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2093
License Number StateOK

VIII. Authorized Official

Name: CATHERINE F CARLIN
Title or Position: OWNER PRESIDENT
Credential: O.D.
Phone: 405-782-0301