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General NPI Number Information
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NPI Number | 1134249683
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Entity Type | Organization
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Legal Business Name | VISION SOURCE OF HUGO, INC.
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 806 E JACKSON ST
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City | HUGO
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State | OK
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Zip | 74743-4222
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Country | US
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Telephone | 580-326-3319
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Fax | 580-326-3310
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Provider Business Mailing Address
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Address Line | 806 E JACKSON ST
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City | HUGO
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State | OK
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Zip | 74743-4222
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Country | US
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Telephone | 580-326-3319
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Fax | 580-326-3310
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. GINNY M EDWARDS
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Credential |
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Telephone | 580-326-3319
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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 | 2096
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License Number State | OK
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