Healthcare Provider Details

I. General information

NPI: 1144204983
Provider Name (Legal Business Name): ERIC RAY KUYKENDALL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 S FLORENCE AVE SUITE 150
CLAREMORE OK
74017-8221
US

IV. Provider business mailing address

221 S FLORENCE AVE 150
CLAREMORE OK
74017-8221
US

V. Phone/Fax

Practice location:
  • Phone: 918-341-2020
  • Fax: 918-341-3888
Mailing address:
  • Phone: 918-341-2020
  • Fax: 918-341-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2161
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: