Healthcare Provider Details

I. General information

NPI: 1427196146
Provider Name (Legal Business Name): DENISE SPEARS RODDY, OD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6351 E. 67TH PL.
TULSA OK
74136-3506
US

IV. Provider business mailing address

PO BOX 990
JENKS OK
74037-0990
US

V. Phone/Fax

Practice location:
  • Phone: 918-497-2002
  • Fax: 918-497-2022
Mailing address:
  • Phone: 918-497-2002
  • Fax: 918-497-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1185
License Number StateOK

VIII. Authorized Official

Name: DR. DENISE SPEARS RODDY
Title or Position: PRESIDENT
Credential: OD
Phone: 918-497-2002