Healthcare Provider Details

I. General information

NPI: 1073772398
Provider Name (Legal Business Name): BRIAN KEITH FIRESTONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 STANTON L YOUNG BLVD
OKLAHOMA CITY OK
73104-5014
US

IV. Provider business mailing address

3037 NW 63RD ST STE W251
OKLAHOMA CITY OK
73116-3637
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-6060
  • Fax: 405-271-7873
Mailing address:
  • Phone: 405-691-0505
  • Fax: 405-691-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD445114
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number30196
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: