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General NPI Number Information
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NPI Number | 1578907598
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Entity Type | Organization
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Legal Business Name | MID-DEL VISION SOURCE PLLC
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Dates
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Enumeration Date | 04/21/2013
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Last Update Date | 06/12/2014
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Provider Practice Location Address
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Address Line | 5113 SE 15TH ST SUITE A
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City | DEL CITY
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State | OK
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Zip | 73115-3952
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Country | US
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Telephone | 405-677-8831
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Fax |
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Provider Business Mailing Address
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Address Line | 5113 SE 15TH ST SUITE A
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City | DEL CITY
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State | OK
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Zip | 73115-3952
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Country | US
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Telephone | 405-677-8831
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Fax |
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Authorized Official
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Title or Position | ASSISTANT DIRECTOR OF OPERATIONS
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Name | MICHELLE STRICKLIN
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Credential |
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Telephone | 405-732-2277
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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 |
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License Number State |
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