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General NPI Number Information
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NPI Number | 1710488275
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Entity Type | Organization
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Legal Business Name | THE EYE SITE, PLLC
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 02/21/2018
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Provider Practice Location Address
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Address Line | 921 OKLAHOMA BLVD STE A
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City | ALVA
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State | OK
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Zip | 73717-2631
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Country | US
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Telephone | 580-732-2393
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Fax |
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Provider Business Mailing Address
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Address Line | 502 MYERS DR
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City | ALVA
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State | OK
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Zip | 73717-3504
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Country | US
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Telephone | 580-732-2393
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CALLIE MOSBURG
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Credential | OD
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Telephone | 580-732-2393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 2861
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License Number State | OK
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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 | 2861
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License Number State | OK
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