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General NPI Number Information
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NPI Number | 1497168587
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Entity Type | Organization
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Legal Business Name | MICHAEL W GAYDOS, OD PC
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 8430 N 123RD EAST AVE
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City | OWASSO
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State | OK
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Zip | 74055-2130
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Country | US
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Telephone | 918-272-5755
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Fax | 918-272-0330
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Provider Business Mailing Address
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Address Line | 8430 N 123RD EAST AVE
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City | OWASSO
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State | OK
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Zip | 74055-2130
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Country | US
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Telephone | 918-272-5755
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Fax | 918-272-0330
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. MICHAEL WILLIAM GAYDOS
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Credential | OD
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Telephone | 918-510-6432
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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 | 2137
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License Number State | OK
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