Healthcare Provider Details

I. General information

NPI: 1104894088
Provider Name (Legal Business Name): ROBERT CHARLES DUKE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 N HIGHWAY 66 SUITE A
CATOOSA OK
74015-2409
US

IV. Provider business mailing address

PO BOX 98
CATOOSA OK
74015-0098
US

V. Phone/Fax

Practice location:
  • Phone: 918-266-3411
  • Fax: 918-266-3412
Mailing address:
  • Phone: 918-266-3411
  • Fax: 918-266-3412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number934
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number934
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: