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General NPI Number Information
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NPI Number | 1033438197
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Entity Type | Organization
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Legal Business Name | KEN MERCHANT,O.D. PLLC
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 10/21/2021
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Provider Practice Location Address
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Address Line | 3334 E 32ND PL
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City | TULSA
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State | OK
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Zip | 74135-4415
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Country | US
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Telephone | 918-622-6244
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Fax | 918-622-9126
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Provider Business Mailing Address
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Address Line | 3334 E 32ND PL
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City | TULSA
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State | OK
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Zip | 74135-4415
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Country | US
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Telephone | 918-622-6244
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Fax | 918-622-9126
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Authorized Official
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Title or Position | OWNER/ OPTOMETRIST
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Name | DR. KENNETH JAMES MERCHANT
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Credential | O.D.
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Telephone | 918-622-6244
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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 | 2074
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License Number State | OK
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