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General NPI Number Information
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NPI Number | 1275753550
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Entity Type | Organization
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Legal Business Name | ROGER L RADELL O D INCORPORATED P C
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 915 9TH STREET
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City | PRAGUE
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State | OK
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Zip | 74864-0507
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Country | US
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Telephone | 405-567-2261
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 507
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City | PRAGUE
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State | OK
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Zip | 74864-0507
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Country | US
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Telephone | 405-567-2261
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROGER LEE RADELL
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Credential | OD
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Telephone | 405-567-2261
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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 | 2024
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License Number State | OK
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