Healthcare Provider Details

I. General information

NPI: 1457597312
Provider Name (Legal Business Name): SAMS OPTICAL OKLAHOMA CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2008
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W I 240 SERVICE RD
OKLAHOMA CITY OK
73139-4400
US

IV. Provider business mailing address

500 W I 240 SERVICE RD
OKLAHOMA CITY OK
73139-4400
US

V. Phone/Fax

Practice location:
  • Phone: 405-778-6227
  • Fax: 405-778-6228
Mailing address:
  • Phone: 405-778-6227
  • Fax: 405-778-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. SHELLY F BERTIN
Title or Position: CO-OWNER
Credential:
Phone: 405-631-7560