Provider Demographics
NPI:1427369974
Name:MIDTOWN OPTICAL PLLC
Entity Type:Organization
Organization Name:MIDTOWN OPTICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GREENHAW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-604-0987
Mailing Address - Street 1:1106 CLASSEN DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2608
Mailing Address - Country:US
Mailing Address - Phone:405-604-0987
Mailing Address - Fax:405-604-3359
Practice Address - Street 1:1106 CLASSEN DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2608
Practice Address - Country:US
Practice Address - Phone:405-604-0987
Practice Address - Fax:405-604-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2526152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty