Healthcare Provider Details

I. General information

NPI: 1669509683
Provider Name (Legal Business Name): J D HUDKINS O D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4008 S ELM PL SUITE A
BROKEN ARROW OK
74011-2021
US

IV. Provider business mailing address

4008 S ELM PL SUITE A
BROKEN ARROW OK
74011-2021
US

V. Phone/Fax

Practice location:
  • Phone: 918-455-2020
  • Fax:
Mailing address:
  • Phone: 918-455-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number909
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number909
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number909
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number909
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number909
License Number StateOK
# 6
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number909
License Number StateOK

VIII. Authorized Official

Name: DANETTE L GUNTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 918-455-2020