Healthcare Provider Details

I. General information

NPI: 1649715608
Provider Name (Legal Business Name): VIZOWN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24962 OKAY RD
TECUMSEH OK
74873-6504
US

IV. Provider business mailing address

24962 OKAY RD
TECUMSEH OK
74873-6504
US

V. Phone/Fax

Practice location:
  • Phone: 405-253-2020
  • Fax: 405-598-8227
Mailing address:
  • Phone: 405-253-2020
  • Fax: 405-598-8227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number12457565
License Number StateOK

VIII. Authorized Official

Name: JOHN RICHARDS
Title or Position: DIRECTOR OF ACCOUNT MANAGEMENT
Credential:
Phone: 561-413-9860