Provider Demographics
NPI:1427196146
Name:DENISE SPEARS RODDY, OD, PC
Entity Type:Organization
Organization Name:DENISE SPEARS RODDY, OD, PC
Other - Org Name:ADVANCED EYE CARE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:SPEARS
Authorized Official - Last Name:RODDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-497-2002
Mailing Address - Street 1:PO BOX 990
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-0990
Mailing Address - Country:US
Mailing Address - Phone:918-497-2002
Mailing Address - Fax:918-497-2022
Practice Address - Street 1:6351 E. 67TH PL.
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3506
Practice Address - Country:US
Practice Address - Phone:918-497-2002
Practice Address - Fax:918-497-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1185152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100762210AMedicaid
OK100762210AMedicaid
OK0458310001Medicare NSC
OKOKB0025Medicare PIN