Healthcare Provider Details

I. General information

NPI: 1871736074
Provider Name (Legal Business Name): AOO VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 N CLASSEN BLVD
OKLAHOMA CITY OK
73118-4837
US

IV. Provider business mailing address

4720 N CLASSEN BLVD
OKLAHOMA CITY OK
73118-4837
US

V. Phone/Fax

Practice location:
  • Phone: 405-528-1220
  • Fax: 405-528-0279
Mailing address:
  • Phone: 405-528-1220
  • Fax: 405-528-0279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JAY WESLEY SPARKS
Title or Position: OPTOMETRIST/MEMBER
Credential: O.D.
Phone: 405-528-1220