Healthcare Provider Details

I. General information

NPI: 1730621178
Provider Name (Legal Business Name): CVI OKLAHOMA, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11308 N PENNSYLVANIA AVE
OKLAHOMA CITY OK
73120-7752
US

IV. Provider business mailing address

1555 PALM BEACH LAKES BLVD
WEST PALM BEACH FL
33401-2323
US

V. Phone/Fax

Practice location:
  • Phone: 405-744-7700
  • Fax:
Mailing address:
  • Phone: 561-965-9110
  • Fax: 561-684-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN BELARDO
Title or Position: OWNER
Credential:
Phone: 405-755-7700