Provider Demographics
NPI:1265682140
Name:ADA VISION INC
Entity Type:Organization
Organization Name:ADA VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-272-9600
Mailing Address - Street 1:500 N MONTE VISTA ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4670
Mailing Address - Country:US
Mailing Address - Phone:580-272-9600
Mailing Address - Fax:580-272-9602
Practice Address - Street 1:500 N MONTE VISTA ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4670
Practice Address - Country:US
Practice Address - Phone:580-272-9600
Practice Address - Fax:580-272-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6174900001Medicare NSC