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General NPI Number Information
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NPI Number | 1215012091
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Entity Type | Organization
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Legal Business Name | KINGFISHER EYE CLINIC INC
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 02/05/2010
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Provider Practice Location Address
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Address Line | 824 S MAIN ST
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City | KINGFISHER
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State | OK
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Zip | 73750-3625
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Country | US
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Telephone | 405-375-5994
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Fax | 405-375-5952
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Provider Business Mailing Address
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Address Line | 824 S MAIN ST
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City | KINGFISHER
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State | OK
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Zip | 73750-3625
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Country | US
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Telephone | 405-375-5994
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Fax | 405-375-5952
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Authorized Official
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Title or Position | OFFICER OF CORPORATION SECRETARY TR
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Name | DR. PAMELA K REICHERT
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Credential | OD
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Telephone | 405-262-2354
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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 |
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License Number State |
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