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General NPI Number Information
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NPI Number | 1225257249
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Entity Type | Organization
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Legal Business Name | MARK B. PRIVOTT, O.D., INC
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 4107 N COUNCIL RD BLDG H
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City | BETHANY
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State | OK
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Zip | 73008-3131
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Country | US
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Telephone | 405-495-5170
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Fax | 405-787-0123
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Provider Business Mailing Address
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Address Line | 4107 N COUNCIL RD BLDG H
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City | BETHANY
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State | OK
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Zip | 73008-3131
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Country | US
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Telephone | 405-495-5170
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Fax | 405-787-0123
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK B PRIVOTT
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Credential | O.D.
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Telephone | 405-495-5170
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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 | 1113
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License Number State | OK
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