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General NPI Number Information
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NPI Number | 1619180999
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Entity Type | Organization
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Legal Business Name | BARNES VISION CLINIC, INC.
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 1911 N COMMERCE ST
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City | ARDMORE
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State | OK
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Zip | 73401-1382
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Country | US
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Telephone | 580-223-0055
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Fax | 580-223-0776
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Provider Business Mailing Address
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Address Line | 1911 N COMMERCE ST
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City | ARDMORE
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State | OK
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Zip | 73401-1382
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Country | US
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Telephone | 580-223-0055
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Fax | 580-223-0776
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TRACI ANN ROYSE
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Credential |
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Telephone | 580-223-0055
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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 | 2066
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License Number State | OK
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