Provider Demographics
NPI:1447397682
Name:BLACKWELL VISION CENTER INC
Entity Type:Organization
Organization Name:BLACKWELL VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHENOWETH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-363-2385
Mailing Address - Street 1:202 E BLACKWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-2910
Mailing Address - Country:US
Mailing Address - Phone:580-363-2385
Mailing Address - Fax:580-363-1618
Practice Address - Street 1:202 E BLACKWELL AVE
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-2910
Practice Address - Country:US
Practice Address - Phone:580-363-2385
Practice Address - Fax:580-363-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2154332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU59642Medicare UPIN
1053280001Medicare NSC
OHOKA103650Medicare PIN