Healthcare Provider Details

I. General information

NPI: 1659924082
Provider Name (Legal Business Name): THE RIVIISION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8811 S SANTA FE AVE
OKLAHOMA CITY OK
73139-8410
US

IV. Provider business mailing address

8811 S SANTA FE AVE
OKLAHOMA CITY OK
73139-8410
US

V. Phone/Fax

Practice location:
  • Phone: 405-990-0643
  • Fax: 405-561-6803
Mailing address:
  • Phone: 405-990-0643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: BYRON BONNER
Title or Position: OWNER
Credential: OD
Phone: 405-990-0643