Provider Demographics
NPI:1790990059
Name:OCULOPLASTIC SURGEONS OF OKLAHOMA, PLLC
Entity Type:Organization
Organization Name:OCULOPLASTIC SURGEONS OF OKLAHOMA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLLOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-521-0041
Mailing Address - Street 1:16315 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8892
Mailing Address - Country:US
Mailing Address - Phone:405-521-0041
Mailing Address - Fax:405-521-1689
Practice Address - Street 1:16315 N MAY AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-8892
Practice Address - Country:US
Practice Address - Phone:405-521-0041
Practice Address - Fax:405-521-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200093160AMedicaid
OK200093160AMedicaid
OKD34362Medicare UPIN
OK300522153Medicare PIN