Provider Demographics
NPI:1033438197
Name:KEN MERCHANT,O.D. PLLC
Entity Type:Organization
Organization Name:KEN MERCHANT,O.D. PLLC
Other - Org Name:KEN MERCHANT, O.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-622-6244
Mailing Address - Street 1:3334 E 32ND PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-4415
Mailing Address - Country:US
Mailing Address - Phone:918-622-6244
Mailing Address - Fax:918-622-9126
Practice Address - Street 1:3334 E 32ND PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-4415
Practice Address - Country:US
Practice Address - Phone:918-622-6244
Practice Address - Fax:918-622-9126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2074152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1073510001Medicare NSC
OKOKA102793Medicare PIN