Healthcare Provider Details

I. General information

NPI: 1285134387
Provider Name (Legal Business Name): MOTLEY VISION PROFESSIONALS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9805 N. MAY AVENUE
OKLAHOMA CITY OK
73120
US

IV. Provider business mailing address

21932 TOSCANA CT
EDMOND OK
73012-0919
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-2020
  • Fax:
Mailing address:
  • Phone: 405-329-5613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2601
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIDGET MOTLEY
Title or Position: OWNER
Credential: O.D.
Phone: 405-749-2020