Provider Demographics
NPI:1033244033
Name:SAMUEL C. OLIPHANT, INC
Entity Type:Organization
Organization Name:SAMUEL C. OLIPHANT, INC
Other - Org Name:VISION SOURCE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:OLIPHANT
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:405-751-7727
Mailing Address - Street 1:14000 QUAILBROOK DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1701
Mailing Address - Country:US
Mailing Address - Phone:405-751-7727
Mailing Address - Fax:405-755-1875
Practice Address - Street 1:14000 QUAILBROOK DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1701
Practice Address - Country:US
Practice Address - Phone:405-751-7727
Practice Address - Fax:405-755-1875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK898152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1033244033OtherNPI, GROUP
OK410022654OtherRR MEDICARE
OK1396750139OtherNPI INDIVIDUAL
OK0617700001Medicare NSC
OK1396750139OtherNPI INDIVIDUAL
OK40594Medicare UPIN
OK249332101Medicare PIN