Provider Demographics
NPI:1043583545
Name:DRK VISION GROUP PLLC
Entity Type:Organization
Organization Name:DRK VISION GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-298-4969
Mailing Address - Street 1:11711 S HUDSON PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-8530
Mailing Address - Country:US
Mailing Address - Phone:918-298-4969
Mailing Address - Fax:918-298-4594
Practice Address - Street 1:11711 S HUDSON PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-8530
Practice Address - Country:US
Practice Address - Phone:918-298-4969
Practice Address - Fax:918-298-4594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1110152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty