| NPI | 1104228105 |
|---|---|
| Doing Business As | SHAWNEE VISION SOURCE |
| Entity Type | Organization |
| Authorized Contact | TREVOR CONKLIN Owner/Partner 405-275-7676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 2690) |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2014-09-22 |