Healthcare Provider Details

I. General information

NPI: 1982011912
Provider Name (Legal Business Name): DENISE BURNS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

19509 E 75TH ST N
OWASSO OK
74055
US

V. Phone/Fax

Practice location:
  • Phone: 918-745-9662
  • Fax: 918-745-9663
Mailing address:
  • Phone: 918-292-2930
  • Fax: 918-272-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2294
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: