Provider Demographics
NPI:1093888356
Name:OKLAHOMA RETINA CONSULTANTS PC
Entity Type:Organization
Organization Name:OKLAHOMA RETINA CONSULTANTS PC
Other - Org Name:OKLAHOMA RETINA INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMIT
Authorized Official - Middle Name:K
Authorized Official - Last Name:NANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-948-2020
Mailing Address - Street 1:3366 NW EXPRESSWAY ST STE 750
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4454
Mailing Address - Country:US
Mailing Address - Phone:405-948-2020
Mailing Address - Fax:405-948-2760
Practice Address - Street 1:3366 NW EXPRESSWAY ST STE 750
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4454
Practice Address - Country:US
Practice Address - Phone:405-948-2020
Practice Address - Fax:405-948-2760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK18577174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200099370AMedicaid
OK200099370AMedicaid
OKE94908Medicare UPIN