MEDICARE: RETINA CONSULTANTS OF OKLAHOMA 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	207W00000X	Ophthalmology Physician	27666	OK

General Provider Information

NPI Number	:	1215245014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA CONSULTANTS OF OKLAHOMA PLLC

Provider Business Mailing Address
First Line	:	3037 NW 63RD ST STE W251
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3637
Country	:	US
Telephone Number	:	405-691-0505
Fax Number	:	405-691-0507

Provider Business Practice Location Address
First Line	:	9821 S MAY AVE STE C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7042
Country	:	US
Telephone Number	:	405-691-0505
Fax Number	:	405-691-0507

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LANCE V SCOTT
Credential	:	MD
Telephone Number	:	405-691-0505

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	12/19/2025

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2816 NW 57TH STREET , SUITE 104
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