Healthcare Provider Details

I. General information

NPI: 1235116898
Provider Name (Legal Business Name): K. DEAN EVANS JR., OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2005
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N HIGHWAY 18
CHANDLER OK
74834-1200
US

IV. Provider business mailing address

113 N HIGHWAY 18
CHANDLER OK
74834-1200
US

V. Phone/Fax

Practice location:
  • Phone: 405-258-1234
  • Fax: 405-258-1236
Mailing address:
  • Phone: 405-258-1234
  • Fax: 405-258-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1175
License Number StateOK

VIII. Authorized Official

Name: DR. KARL DEAN EVANS JR.
Title or Position: PRESIDENT
Credential: OD
Phone: 405-258-1234