Healthcare Provider Details

I. General information

NPI: 1558012922
Provider Name (Legal Business Name): OCULAR PHYSICIANS OF CHICKASHA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W IOWA AVE
CHICKASHA OK
73018-2738
US

IV. Provider business mailing address

11308 N PENNSYLVANIA AVE
OKLAHOMA CITY OK
73120-7752
US

V. Phone/Fax

Practice location:
  • Phone: 405-818-6097
  • Fax:
Mailing address:
  • Phone: 405-818-6097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LEWIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 405-755-7700