Provider Demographics
NPI:1477623700
Name:UNIVERSITY OF OKLAHOMA HEAL SCI CTR COLLEGE OF MEDICINE OPHTHALMOLOGY
Entity Type:Organization
Organization Name:UNIVERSITY OF OKLAHOMA HEAL SCI CTR COLLEGE OF MEDICINE OPHTHALMOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARYL
Authorized Official - Middle Name:G
Authorized Official - Last Name:GEIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-271-5214
Mailing Address - Street 1:608 STANTON L YOUNG BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5014
Mailing Address - Country:US
Mailing Address - Phone:405-271-6060
Mailing Address - Fax:405-271-3013
Practice Address - Street 1:608 STANTON L YOUNG BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5014
Practice Address - Country:US
Practice Address - Phone:405-271-6060
Practice Address - Fax:405-271-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200025250AMedicaid
OK731069165Medicare ID - Type Unspecified