Provider Demographics
NPI:1598989543
Name:OKLAHOMA VISION DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:OKLAHOMA VISION DEVELOPMENT CENTER
Other - Org Name:HARREL EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:ELVIN
Authorized Official - Last Name:HARRRELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-745-9662
Mailing Address - Street 1:4520 S HARVARD AVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2925
Mailing Address - Country:US
Mailing Address - Phone:918-745-9662
Mailing Address - Fax:918-745-9663
Practice Address - Street 1:4520 S HARVARD AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2925
Practice Address - Country:US
Practice Address - Phone:918-745-9662
Practice Address - Fax:918-745-9663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2304152W00000X, 152WP0200X, 152WV0400X
OK2336152W00000X, 152WC0802X
OK2510152W00000X
OK2573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU87300Medicare UPIN
OK4570430001Medicare NSC
OKU82287Medicare UPIN