Provider Demographics
NPI:1306212667
Name:TRI CITY VISION CENTER, PLLC
Entity Type:Organization
Organization Name:TRI CITY VISION CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:FURNISH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-387-4884
Mailing Address - Street 1:PO BOX 1465
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-1465
Mailing Address - Country:US
Mailing Address - Phone:405-387-4884
Mailing Address - Fax:405-387-2772
Practice Address - Street 1:918 NW 32ND ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6605
Practice Address - Country:US
Practice Address - Phone:405-387-4884
Practice Address - Fax:405-387-2772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2451261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center