Healthcare Provider Details

I. General information

NPI: 1184364093
Provider Name (Legal Business Name): CODY SCOTT WARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 09/25/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 E 81ST ST STE 100
TULSA OK
74133-4558
US

IV. Provider business mailing address

23522 230TH ST.
FERGUS FALLS MN
56537
US

V. Phone/Fax

Practice location:
  • Phone: 918-444-4000
  • Fax:
Mailing address:
  • Phone: 218-205-7875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3207
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: