Provider Demographics
NPI:1043391907
Name:FURNISH, BRET CONNER (OD)
Entity Type:Individual
Prefix:DR
First Name:BRET
Middle Name:CONNER
Last Name:FURNISH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 NW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-6605
Mailing Address - Country:US
Mailing Address - Phone:405-387-4884
Mailing Address - Fax:405-387-2772
Practice Address - Street 1:918 NW 32ND ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6605
Practice Address - Country:US
Practice Address - Phone:405-387-4884
Practice Address - Fax:405-387-2772
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2451152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200062350AMedicaid
OK200062350AMedicaid
OK730956509Medicare PIN