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General NPI Number Information
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NPI Number | 1588652705
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Entity Type | Organization
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Legal Business Name | J CHRIS HUMMEL MD PC
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 4205 MCAULEY BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-8347
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Country | US
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Telephone | 405-755-6111
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Fax | 405-755-6298
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Provider Business Mailing Address
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Address Line | 4205 MCAULEY BLVD STE 401
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-8347
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Country | US
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Telephone | 405-755-6111
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Fax | 405-755-6298
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CYNTHIA LEA FREITAG
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Credential |
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Telephone | 405-755-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 19601
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License Number State | OK
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