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General NPI Number Information
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NPI Number | 1013612209
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Entity Type | Individual
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Provider Name | JADICA LOUISE BENDURE
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Gender | Female
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 5350 E 31ST ST STE 300
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City | TULSA
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State | OK
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Zip | 74135-5011
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Country | US
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Telephone | 918-933-4075
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Fax |
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Provider Business Mailing Address
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Address Line | 520 BELMONT RD
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City | MUSKOGEE
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State | OK
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Zip | 74403-3911
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Country | US
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Telephone | 918-360-3569
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3238
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License Number State | OK
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