Provider Demographics
NPI:1518090414
Name:QUAIL SPRINGS OPTICAL SERVICES, PC
Entity Type:Organization
Organization Name:QUAIL SPRINGS OPTICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KISH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-755-0620
Mailing Address - Street 1:2501 W MEMORIAL RD
Mailing Address - Street 2:SUITE 132A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-8039
Mailing Address - Country:US
Mailing Address - Phone:405-755-0620
Mailing Address - Fax:405-755-0734
Practice Address - Street 1:2501 W MEMORIAL RD
Practice Address - Street 2:SUITE 132A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-8039
Practice Address - Country:US
Practice Address - Phone:405-755-0620
Practice Address - Fax:405-755-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty