Provider Demographics
NPI:1114935228
Name:VISION & EYE MEDICAL DIAGNOSTIC & LASER CENTER, INC.
Entity Type:Organization
Organization Name:VISION & EYE MEDICAL DIAGNOSTIC & LASER CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-266-3411
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:2310 N HIGHWAY 66
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-0098
Mailing Address - Country:US
Mailing Address - Phone:918-266-3411
Mailing Address - Fax:918-266-3412
Practice Address - Street 1:2319 N. HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74127
Practice Address - Country:US
Practice Address - Phone:918-266-3411
Practice Address - Fax:918-266-3412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK934152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty