Healthcare Provider Details

I. General information

NPI: 1881802718
Provider Name (Legal Business Name): P A GELWICK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 S HARVARD AVE
TULSA OK
74112-6823
US

IV. Provider business mailing address

1633 S HARVARD AVE
TULSA OK
74112-6823
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-7638
  • Fax: 918-744-5384
Mailing address:
  • Phone: 918-744-7638
  • Fax: 918-744-5384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP ALLEN GELWICK
Title or Position: PRESIDENT
Credential: O. D.
Phone: 918-744-7638