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General NPI Number Information
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NPI Number | 1154441848
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Entity Type | Organization
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Legal Business Name | BROADWAY VISION ASSOCIATES, PLC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 435 W BROADWAY ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-6614
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Country | US
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Telephone | 918-687-4459
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Fax | 918-687-0238
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Provider Business Mailing Address
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Address Line | 435 W BROADWAY ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-6614
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Country | US
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Telephone | 918-687-4459
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Fax | 918-687-0238
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Authorized Official
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Title or Position | OD OWNER
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Name | DR. CANDACE Y. STEWART
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Credential | OD
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Telephone | 918-687-4459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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