Provider Demographics
NPI:1508948548
Name:BRUNK, BILLY JOE (OD)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:JOE
Last Name:BRUNK
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 1:816 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-3453
Mailing Address - Country:US
Mailing Address - Phone:918-696-6717
Mailing Address - Fax:918-696-6717
Practice Address - Street 1:816 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-3453
Practice Address - Country:US
Practice Address - Phone:918-696-6717
Practice Address - Fax:918-696-6717
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK540012215OtherRAILROAD RETIREMENT BOARD
OK100766100AMedicaid
OK100766100AMedicaid
OK6182960001Medicare NSC
OKT40376Medicare UPIN