Provider Demographics
NPI:1215032883
Name:HISKETT AND ELLIOTT PTR
Entity Type:Organization
Organization Name:HISKETT AND ELLIOTT PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HISKETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-367-2020
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-0719
Mailing Address - Country:US
Mailing Address - Phone:918-367-2020
Mailing Address - Fax:918-367-9542
Practice Address - Street 1:121 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-2501
Practice Address - Country:US
Practice Address - Phone:918-367-2020
Practice Address - Fax:918-367-9542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0331570001Medicare NSC