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General NPI Number Information
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NPI Number | 1093966798
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Entity Type | Organization
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Legal Business Name | RIVERSIDE EYE CLINIC
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Dates
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Enumeration Date | 10/01/2008
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 524 E MAIN ST
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City | JENKS
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State | OK
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Zip | 74037-4137
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Country | US
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Telephone | 918-296-4733
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Fax | 918-296-4734
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Provider Business Mailing Address
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Address Line | 524 E MAIN ST
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City | JENKS
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State | OK
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Zip | 74037-4137
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Country | US
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Telephone | 918-296-4733
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Fax | 918-296-4734
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Authorized Official
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Title or Position | OWNER
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Name | DR. TAMMY M SCHEFF-PAUL
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Credential | OD
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Telephone | 918-296-4733
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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 | 2205
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License Number State | OK
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