Provider Demographics
NPI:1558734970
Name:HOLDENVILLE EYE CENTER PLLC
Entity Type:Organization
Organization Name:HOLDENVILLE EYE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAVALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-379-3700
Mailing Address - Street 1:720 N HINCKLEY ST
Mailing Address - Street 2:
Mailing Address - City:HOLDENVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74848-3841
Mailing Address - Country:US
Mailing Address - Phone:405-379-3700
Mailing Address - Fax:405-379-3712
Practice Address - Street 1:720 N HINCKLEY ST
Practice Address - Street 2:
Practice Address - City:HOLDENVILLE
Practice Address - State:OK
Practice Address - Zip Code:74848-3841
Practice Address - Country:US
Practice Address - Phone:405-379-3700
Practice Address - Fax:405-379-3712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty