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General NPI Number Information
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NPI Number | 1972639722
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Entity Type | Organization
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Legal Business Name | OWASSO EYE INSTITUTE INC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 11/21/2008
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Provider Practice Location Address
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Address Line | 12455 E 100TH ST N SUITE 110
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City | OWASSO
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State | OK
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Zip | 74055-4600
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Country | US
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Telephone | 918-274-7100
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Fax | 918-274-7128
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Provider Business Mailing Address
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Address Line | 12455 E 100TH ST N SUITE 110
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City | OWASSO
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State | OK
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Zip | 74055-4600
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Country | US
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Telephone | 918-274-7100
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Fax | 918-274-7128
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TINA HULL
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Credential |
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Telephone | 918-747-3937
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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 | 2300
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License Number State | OK
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