Healthcare Provider Details

I. General information

NPI: 1598989543
Provider Name (Legal Business Name): OKLAHOMA VISION DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 S HARVARD AVE SUITE 135
TULSA OK
74135-2925
US

IV. Provider business mailing address

4520 S HARVARD AVE SUITE 135
TULSA OK
74135-2925
US

V. Phone/Fax

Practice location:
  • Phone: 918-745-9662
  • Fax: 918-745-9663
Mailing address:
  • Phone: 918-745-9662
  • Fax: 918-745-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2510
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2573
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2336
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2336
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number2304
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number2304
License Number StateOK
# 7
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2304
License Number StateOK

VIII. Authorized Official

Name: DR. MONTE ELVIN HARRRELL
Title or Position: CEO
Credential: OD
Phone: 918-745-9662