Provider Demographics
NPI:1821116971
Name:UNIVERSITY OPTICAL, INC.
Entity Type:Organization
Organization Name:UNIVERSITY OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MASTERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:405-364-8220
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-0579
Mailing Address - Country:US
Mailing Address - Phone:405-364-8220
Mailing Address - Fax:405-579-8409
Practice Address - Street 1:2201 MCKOWN DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-6601
Practice Address - Country:US
Practice Address - Phone:405-364-8220
Practice Address - Fax:405-579-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0186390001Medicare ID - Type Unspecified
OK0186390001Medicare NSC