Provider Demographics
NPI:1578907598
Name:MID-DEL VISION SOURCE PLLC
Entity Type:Organization
Organization Name:MID-DEL VISION SOURCE PLLC
Other - Org Name:VISION SOURCE DEL CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRICKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-732-2277
Mailing Address - Street 1:5113 SE 15TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-3952
Mailing Address - Country:US
Mailing Address - Phone:405-677-8831
Mailing Address - Fax:
Practice Address - Street 1:5113 SE 15TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3952
Practice Address - Country:US
Practice Address - Phone:405-677-8831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-DEL VISION SOURCE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-21
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier