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General NPI Number Information
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NPI Number | 1750300992
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Entity Type | Individual
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Provider Name | CHRISTOPHER RAY CHENOWETH O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 502 E PROSPECT AVE
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City | PONCA CITY
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State | OK
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Zip | 74601-7404
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Country | US
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Telephone | 580-765-7509
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Fax | 580-765-2886
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Provider Business Mailing Address
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Address Line | 502 E PROSPECT AVE
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City | PONCA CITY
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State | OK
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Zip | 74601-7404
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Country | US
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Telephone | 580-765-7509
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Fax | 580-765-2886
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2154
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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 | 2154
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | 2154
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 2154
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License Number State | OK
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2154
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License Number State | OK
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