Provider Demographics
NPI:1346424637
Name:SUCCESS VISION EXPRESS OF SAND SPRINGS, LLC
Entity Type:Organization
Organization Name:SUCCESS VISION EXPRESS OF SAND SPRINGS, LLC
Other - Org Name:DR. PRESLEY & ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVYDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-800-2020
Mailing Address - Street 1:7472 E ADMIRAL PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115
Mailing Address - Country:US
Mailing Address - Phone:918-794-9029
Mailing Address - Fax:
Practice Address - Street 1:230 S HIGHWAY 97 STE B
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-6571
Practice Address - Country:US
Practice Address - Phone:918-241-2020
Practice Address - Fax:918-241-0215
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUCCESS VISION EXPRESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-21
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty