=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215922737
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AARON MICHAEL SCAVEZZE OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2005
-----------------------------------------------------
Last Update Date | 04/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10651 E 31ST ST
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74146-1602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-437-6360
-----------------------------------------------------
Fax | 918-437-6362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10651 E 31ST ST
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74146-1602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-437-6360
-----------------------------------------------------
Fax | 918-437-6362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2229
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------