Healthcare Provider Details

I. General information

NPI: 1790990059
Provider Name (Legal Business Name): OCULOPLASTIC SURGEONS OF OKLAHOMA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16315 N MAY AVE
EDMOND OK
73013-8892
US

IV. Provider business mailing address

16315 N MAY AVE
EDMOND OK
73013-8892
US

V. Phone/Fax

Practice location:
  • Phone: 405-521-0041
  • Fax: 405-521-1689
Mailing address:
  • Phone: 405-521-0041
  • Fax: 405-521-1689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ERIN L HOLLOMAN
Title or Position: MANAGER
Credential: M.D.
Phone: 405-521-0041