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General NPI Number Information
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NPI Number | 1447397682
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Entity Type | Organization
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Legal Business Name | BLACKWELL VISION CENTER INC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 202 E BLACKWELL AVE
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City | BLACKWELL
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State | OK
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Zip | 74631-2910
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Country | US
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Telephone | 580-363-2385
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Fax | 580-363-1618
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Provider Business Mailing Address
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Address Line | 202 E BLACKWELL AVE
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City | BLACKWELL
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State | OK
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Zip | 74631-2910
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Country | US
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Telephone | 580-363-2385
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Fax | 580-363-1618
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER R CHENOWETH
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Credential | OD
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Telephone | 580-363-2385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 2154
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License Number State | OK
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