Provider Demographics
NPI:1417308818
Name:NORTHWEST OPTICAL
Entity Type:Organization
Organization Name:NORTHWEST OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:KORBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-947-3330
Mailing Address - Street 1:3301 NW 63RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3705
Mailing Address - Country:US
Mailing Address - Phone:405-947-3330
Mailing Address - Fax:405-947-3494
Practice Address - Street 1:3301 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3705
Practice Address - Country:US
Practice Address - Phone:405-947-3330
Practice Address - Fax:405-947-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty