Healthcare Provider Details

I. General information

NPI: 1174054860
Provider Name (Legal Business Name): SHEHZAD Y BATLIWALA D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 E 81ST ST STE 100
TULSA OK
74133-4558
US

IV. Provider business mailing address

22715 E 102ND PL S
BROKEN ARROW OK
74014-2473
US

V. Phone/Fax

Practice location:
  • Phone: 918-250-2020
  • Fax:
Mailing address:
  • Phone: 903-262-7212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number6361
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberT5827
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: