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General NPI Number Information
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NPI Number | 1134384241
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Entity Type | Organization
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Legal Business Name | COMPLETE VISION CARE, PLLC
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 08/11/2009
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Provider Practice Location Address
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Address Line | 521 E HARTFORD AVE
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City | PONCA CITY
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State | OK
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Zip | 74601-2004
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Country | US
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Telephone | 580-765-3379
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Fax | 580-765-6323
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Provider Business Mailing Address
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Address Line | 521 E HARTFORD AVE
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City | PONCA CITY
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State | OK
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Zip | 74601-2004
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Country | US
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Telephone | 580-765-3379
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Fax | 580-765-6323
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN ZWANZIGER
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Credential | O.D.
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Telephone | 580-765-3379
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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 | 2588
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License Number State | OK
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