Healthcare Provider Details

I. General information

NPI: 1851630313
Provider Name (Legal Business Name): NJVOC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 HEFNER POINTE DR STE 101
OKLAHOMA CITY OK
73120-5065
US

IV. Provider business mailing address

10900 HEFNER POINTE DR STE 101
OKLAHOMA CITY OK
73120-5065
US

V. Phone/Fax

Practice location:
  • Phone: 405-842-6060
  • Fax: 405-842-6130
Mailing address:
  • Phone: 405-842-6060
  • Fax: 405-842-6130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DAWN HOLSTED
Title or Position: PRESIDENT & CEO
Credential: O.D.
Phone: 405-590-9698