Healthcare Provider Details

I. General information

NPI: 1063347110
Provider Name (Legal Business Name): CASEY NOLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7472 E ADMIRAL PL
TULSA OK
74115-7913
US

IV. Provider business mailing address

406 E KEETOOWAH ST
TAHLEQUAH OK
74464-4112
US

V. Phone/Fax

Practice location:
  • Phone: 918-836-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3361
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: