Healthcare Provider Details

I. General information

NPI: 1215245014
Provider Name (Legal Business Name): RETINA CONSULTANTS OF OKLAHOMA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9821 S MAY AVE STE C
OKLAHOMA CITY OK
73159-7042
US

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number27666
License Number StateOK

VIII. Authorized Official

Name: LANCE V SCOTT
Title or Position: PRESIDENT
Credential: MD
Phone: 405-691-0505