Provider Demographics
NPI:1497750251
Name:VENARD, MAX D (OD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:D
Last Name:VENARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 CITY AVE
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3819
Mailing Address - Country:US
Mailing Address - Phone:405-794-7544
Mailing Address - Fax:405-794-7599
Practice Address - Street 1:705 CITY AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3819
Practice Address - Country:US
Practice Address - Phone:405-794-7544
Practice Address - Fax:405-794-7599
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK0932152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100763670AMedicaid
OK730942327002OtherBCBS
OK1041330001OtherDMEPOS
OK444528043Medicare ID - Type Unspecified
OK100763670AMedicaid