| NPI | 1720116932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT MICHAEL CARLSON President 918-396-4440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 2211) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: OK 2211) |
| 152WP0200X Optometrist Pediatrics (Licence: OK 2211) | |
| 152WS0006X Optometrist Sports Vision (Licence: OK 2211) | |
| 156FX1201X Technician/Technologist Optometric Assistant (Licence: OK 2211) | |
| 156FX1800X Technician/Technologist Optician (Licence: OK 2211) | |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2009-09-16 |