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General NPI Number Information
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NPI Number | 1376761627
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Entity Type | Individual
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Provider Name | ELIZABETH M. HART-CARLOCK O.D.
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 2000 W MEMORIAL RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-6506
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Country | US
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Telephone | 405-876-6393
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 W MEMORIAL RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-6506
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Country | US
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Telephone | 405-876-6393
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Fax |
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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 | OPT003209
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3130
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License Number State | OK
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