Healthcare Provider Details

I. General information

NPI: 1497932412
Provider Name (Legal Business Name): DRS HISKETT ELLIOTT & CANTRELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E 7TH
BRISTOW OK
74010-2501
US

IV. Provider business mailing address

PO BOX 719
BRISTOW OK
74010-0719
US

V. Phone/Fax

Practice location:
  • Phone: 918-367-2020
  • Fax: 918-367-9542
Mailing address:
  • Phone: 918-367-2020
  • Fax: 918-367-9542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateOK

VIII. Authorized Official

Name: DR. ZEDDIE CANTRELL JR.
Title or Position: MANAGER
Credential: OD
Phone: 918-367-2020