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General NPI Number Information
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NPI Number | 1053803635
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Entity Type | Organization
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Legal Business Name | SOUTH TULSA VISION DEVELOPMENT
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 8988 S SHERIDAN RD STE D1
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City | TULSA
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State | OK
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Zip | 74133-5035
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Country | US
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Telephone | 918-949-4002
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Fax | 918-949-4021
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Provider Business Mailing Address
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Address Line | 8988 S SHERIDAN RD STE D1
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City | TULSA
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State | OK
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Zip | 74133-5035
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Country | US
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Telephone | 918-949-4002
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Fax | 918-949-4021
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Authorized Official
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Title or Position | CREDENTIALING AND AR SPECIALIST
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Name | MS. MEGAN M FORD
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Credential |
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Telephone | 918-872-8735
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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 | 2784
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License Number State | OK
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