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General NPI Number Information
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NPI Number | 1336586122
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Entity Type | Individual
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Provider Name | JOHN R DIVER O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 4606 E. 67TH ST SUITE 400, BLDG. #7
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City | TULSA
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State | OK
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Zip | 74136
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Country | US
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Telephone | 918-949-9898
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Fax | 918-728-8091
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Provider Business Mailing Address
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Address Line | 4606 E. 67TH ST SUITE 400, BLDG. #7
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City | TULSA
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State | OK
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Zip | 74136
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Country | US
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Telephone | 918-949-9898
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Fax | 918-728-8091
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2726
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License Number State | OK
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