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General NPI Number Information
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NPI Number | 1043583545
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Entity Type | Organization
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Legal Business Name | DRK VISION GROUP PLLC
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Dates
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Enumeration Date | 02/14/2012
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Last Update Date | 12/20/2016
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Provider Practice Location Address
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Address Line | 11711 S HUDSON PL
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City | TULSA
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State | OK
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Zip | 74137-8530
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Country | US
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Telephone | 918-298-4969
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Fax | 918-298-4594
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Provider Business Mailing Address
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Address Line | 11711 S HUDSON PL
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City | TULSA
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State | OK
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Zip | 74137-8530
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Country | US
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Telephone | 918-298-4969
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Fax | 918-298-4594
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. DAVID KOLKER
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Credential | O.D.
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Telephone | 918-298-4969
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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 | 1110
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License Number State | OK
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