Healthcare Provider Details

I. General information

NPI: 1386721025
Provider Name (Legal Business Name): KRIS L TESIO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7199 SE 29TH ST SUITE 110-B
MIDWEST CITY OK
73110-6003
US

IV. Provider business mailing address

7199 SE 29TH ST SUITE 110-B
MIDWEST CITY OK
73110-6003
US

V. Phone/Fax

Practice location:
  • Phone: 405-737-6681
  • Fax: 405-737-6681
Mailing address:
  • Phone: 405-737-6681
  • Fax: 405-737-6681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1143
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: