Healthcare Provider Details

I. General information

NPI: 1205633633
Provider Name (Legal Business Name): VISIONARY REALM OPTOMETRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 MIDTOWN PL
MIDWEST CITY OK
73130-6347
US

IV. Provider business mailing address

1620 MIDTOWN PL
MIDWEST CITY OK
73130-6347
US

V. Phone/Fax

Practice location:
  • Phone: 405-458-9393
  • Fax: 405-610-0321
Mailing address:
  • Phone: 405-458-9393
  • Fax: 405-610-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALICHIA COX
Title or Position: OPTOMETRIST
Credential: OD
Phone: 405-458-9393