Healthcare Provider Details

I. General information

NPI: 1073673802
Provider Name (Legal Business Name): R.W. VARLEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 W CHICKASHA AVE
CHICKASHA OK
73018-2412
US

IV. Provider business mailing address

508 W CHICKASHA AVE
CHICKASHA OK
73018-2412
US

V. Phone/Fax

Practice location:
  • Phone: 405-222-1270
  • Fax: 405-224-5093
Mailing address:
  • Phone: 405-222-1270
  • Fax: 405-224-5093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number930
License Number StateOK

VIII. Authorized Official

Name: DR. RICHARD WILSON VARLEY
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 405-222-1270