MEDICARE: VISUAL-EYES 2 PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OK2023	OK

General Provider Information

NPI Number	:	1144414194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISUAL-EYES 2 PLLC

Provider Business Mailing Address
First Line	:	9648 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2714
Country	:	US
Telephone Number	:	405-749-2002
Fax Number	:	405-748-5704

Provider Business Practice Location Address
First Line	:	9648 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2714
Country	:	US
Telephone Number	:	405-749-2002
Fax Number	:	405-748-5704

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KENNETH PLANK
Credential	:	OD
Telephone Number	:	405-749-2002

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	02/08/2010

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