Healthcare Provider Details

I. General information

NPI: 1063192326
Provider Name (Legal Business Name): NATHAN ERIC KUYKENDALL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 S FLORENCE AVE STE 150
CLAREMORE OK
74017-7263
US

IV. Provider business mailing address

221 S FLORENCE AVE STE 150
CLAREMORE OK
74017-7263
US

V. Phone/Fax

Practice location:
  • Phone: 918-341-2020
  • Fax:
Mailing address:
  • Phone: 918-341-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3229
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: