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General NPI Number Information
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NPI Number | 1861968992
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Entity Type | Organization
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Legal Business Name | SENIORVISION OF OKLAHOMA LLC
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Dates
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Enumeration Date | 10/16/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 10107 S GARNETT RD
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City | BROKEN ARROW
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State | OK
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Zip | 74011-1118
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Country | US
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Telephone | 918-252-0590
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Fax | 918-252-0591
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Provider Business Mailing Address
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Address Line | 11063D S MEMORIAL DR # 515
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City | TULSA
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State | OK
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Zip | 74133-7362
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Country | US
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Telephone | 918-298-4969
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Fax | 918-298-4594
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | NANCY KOLKER
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Credential |
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Telephone | 918-298-4969
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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 |
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License Number State |
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