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General NPI Number Information
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NPI Number | 1730387846
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Entity Type | Organization
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Legal Business Name | JOHN B. MINNETT, O.D. INC.
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 619 W CHICKASHA AVE
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City | CHICKASHA
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State | OK
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Zip | 73018-2413
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Country | US
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Telephone | 405-224-5342
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Fax | 405-222-2819
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Provider Business Mailing Address
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Address Line | 619 W CHICKASHA AVE P.O. BOX 1599
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City | CHICKASHA
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State | OK
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Zip | 73018-2413
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Country | US
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Telephone | 405-224-5342
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Fax | 405-222-2819
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. CHRISTEN ROBERSON CLIFT
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Credential | O.D.
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Telephone | 405-224-5342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 2155
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 2155
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License Number State | OK
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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 | 2155
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2155
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License Number State | OK
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