Healthcare Provider Details

I. General information

NPI: 1801951058
Provider Name (Legal Business Name): ELISABETH ANN WENTZ-HARRINGTON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7472 E ADMIRAL PL
TULSA OK
74115-7913
US

IV. Provider business mailing address

19899 E 768 RD
TAHLEQUAH OK
74464-0522
US

V. Phone/Fax

Practice location:
  • Phone: 918-834-2929
  • Fax: 918-834-4005
Mailing address:
  • Phone: 918-456-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2029
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: