Provider Demographics
NPI:1275243883
Name:BLACKWELL VISION CENTER INC
Entity Type:Organization
Organization Name:BLACKWELL VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CHENOWETH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-765-7509
Mailing Address - Street 1:502 E PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-7404
Mailing Address - Country:US
Mailing Address - Phone:580-765-7509
Mailing Address - Fax:580-765-2886
Practice Address - Street 1:17 S OAK ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4312
Practice Address - Country:US
Practice Address - Phone:918-224-2610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty