Provider Demographics
NPI:1588652705
Name:J CHRIS HUMMEL MD
Entity Type:Organization
Organization Name:J CHRIS HUMMEL MD
Other - Org Name:THE OPTICAL SHOP
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-755-6111
Mailing Address - Street 1:4205 MCAULEY BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8347
Mailing Address - Country:US
Mailing Address - Phone:405-755-6111
Mailing Address - Fax:405-755-6298
Practice Address - Street 1:4205 MCAULEY BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8347
Practice Address - Country:US
Practice Address - Phone:405-755-6111
Practice Address - Fax:405-755-6298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19601332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKDA2950Medicare PIN
OK4093570002Medicare NSC