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NPI Code Detail

MEDICARE: CHARLES S OLEARY PAC

MEDICARE: CHARLES S OLEARY PAC
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
1363AM0700XMedical Physician AssistantPA 359OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710177738
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES S OLEARY PAC
Provider Business Mailing Address
First Line : 1400 W PAWNEE ST
Second Line :
City : CLEVELAND
State : OK
Zip : 74020-3020
Country : US
Telephone Number : 918-358-3588
Fax Number : 918-358-2639
Provider Business Practice Location Address
First Line : 1400 W PAWNEE ST
Second Line :
City : CLEVELAND
State : OK
Zip : 74020-3020
Country : US
Telephone Number : 918-358-3588
Fax Number : 918-358-2637
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2007
Last Update Date : 12/07/2020

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Directions to “ CHARLES S OLEARY PAC” Practice Location

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