Provider Demographics
NPI:1245240217
Name:GURLEY, CHARLES WENDELL II (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WENDELL
Last Name:GURLEY
Suffix:II
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1433 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2636
Mailing Address - Country:US
Mailing Address - Phone:580-332-5606
Mailing Address - Fax:580-332-3946
Practice Address - Street 1:1433 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2636
Practice Address - Country:US
Practice Address - Phone:580-332-5606
Practice Address - Fax:580-332-3946
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1108152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100764370AMedicaid