Healthcare Provider Details

I. General information

NPI: 1396880506
Provider Name (Legal Business Name): ASSOCIATED OPTOMETRISTS OF OKLAHOMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 04/20/2008
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: 405-528-1207
  • Fax:
Mailing address:
  • Phone: 405-528-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE MARK REDWINE
Title or Position: OWNER
Credential: OD
Phone: 405-528-1207