| NPI | 1639233612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA LYNN POAGE Owner 405-256-0126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 2430) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OK 2430) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: OK 2430) | |
| 152WP0200X Optometrist, Pediatrics (Licence: OK 2430) | |
| 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: OK 2430) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2024-06-13 |