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NPI Code Detail

MEDICARE: VIZOWN, LLC

MEDICARE: VIZOWN, LLC
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
1207QA0401XAddiction Medicine (Family Medicine) Physician12457565OK

General Provider Information

NPI Number : 1649715608
Entity Type Code : Organization
Provider Name (Legal Business Name) : VIZOWN, LLC
Provider Business Mailing Address
First Line : 24962 OKAY RD
Second Line :
City : TECUMSEH
State : OK
Zip : 74873-6504
Country : US
Telephone Number : 405-253-2020
Fax Number : 405-598-8227
Provider Business Practice Location Address
First Line : 24962 OKAY RD
Second Line :
City : TECUMSEH
State : OK
Zip : 74873-6504
Country : US
Telephone Number : 405-253-2020
Fax Number : 405-598-8227
Authorized Official
Title or Position : DIRECTOR OF ACCOUNT MANAGEMENT
Name : JOHN RICHARDS
Credential :
Telephone Number : 561-413-9860
Provider Enumeration Date : 12/30/2016
Last Update Date : 12/30/2016

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Directions to “VIZOWN, LLC ” Practice Location

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