Healthcare Provider Details

I. General information

NPI: 1386897494
Provider Name (Legal Business Name): DENVER C. RUSHING, O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 W MAIN ST
HEALDTON OK
73438-2117
US

IV. Provider business mailing address

335 W MAIN ST
HEALDTON OK
73438-2117
US

V. Phone/Fax

Practice location:
  • Phone: 580-229-2211
  • Fax: 580-229-2212
Mailing address:
  • Phone: 580-229-2211
  • Fax: 580-229-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2542
License Number StateOK

VIII. Authorized Official

Name: DR. DENVER CHARLES RUSHING
Title or Position: PRESIDENT
Credential: O.D.
Phone: 580-229-2211