Healthcare Provider Details

I. General information

NPI: 1356348783
Provider Name (Legal Business Name): AFFORDABLE PRICE VISION CTR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date: 02/13/2006
Reactivation Date: 02/22/2006

III. Provider practice location address

2700 SW 29TH ST
OKLAHOMA CITY OK
73119-1806
US

IV. Provider business mailing address

2700 SW 29TH ST
OKLAHOMA CITY OK
73119-1806
US

V. Phone/Fax

Practice location:
  • Phone: 405-632-9749
  • Fax: 405-632-6331
Mailing address:
  • Phone: 405-632-9749
  • Fax: 405-632-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number809
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number809
License Number StateOK

VIII. Authorized Official

Name: DR. CHRIS J FRY
Title or Position: OPTOMETRIST CO OWNER
Credential: OD
Phone: 405-632-9749