Healthcare Provider Details

I. General information

NPI: 1942229943
Provider Name (Legal Business Name): DEBRA JEAN BEZAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8829 S KINGSTON AVE
TULSA OK
74137-3000
US

IV. Provider business mailing address

8829 S KINGSTON AVE
TULSA OK
74137-3000
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-0166
  • Fax: 918-494-0166
Mailing address:
  • Phone: 918-494-0166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1040
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: