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General NPI Number Information
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NPI Number | 1205999471
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Entity Type | Organization
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Legal Business Name | THOMAS H BERENSON O D P C
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3300 S ASPEN AVE STE D
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City | BROKEN ARROW
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State | OK
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Zip | 74012-7501
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Country | US
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Telephone | 918-451-2020
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Fax | 918-449-9086
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Provider Business Mailing Address
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Address Line | 3300 S ASPEN AVE STE D
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City | BROKEN ARROW
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State | OK
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Zip | 74012-7501
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Country | US
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Telephone | 918-451-2020
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Fax | 918-449-9086
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS H BERENSON
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Credential | OD
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Telephone | 918-451-2020
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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 | 795
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License Number State | OK
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