Healthcare Provider Details

I. General information

NPI: 1972295400
Provider Name (Legal Business Name): KAYLEE BOBBITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 S LEWIS AVE
TULSA OK
74105-7112
US

IV. Provider business mailing address

5910 S LEWIS AVE
TULSA OK
74105-7112
US

V. Phone/Fax

Practice location:
  • Phone: 918-745-9700
  • Fax: 918-743-8102
Mailing address:
  • Phone: 918-745-9700
  • Fax: 918-743-8102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3214
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: