Provider Demographics
NPI:1801417464
Name:CHERIAN, BIBIN J (OD)
Entity Type:Individual
Prefix:
First Name:BIBIN
Middle Name:J
Last Name:CHERIAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W COVELL RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2346
Mailing Address - Country:US
Mailing Address - Phone:405-341-2062
Mailing Address - Fax:405-341-6553
Practice Address - Street 1:200 W COVELL RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-2346
Practice Address - Country:US
Practice Address - Phone:405-341-2062
Practice Address - Fax:405-341-6553
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist