Provider Demographics
NPI:1841769791
Name:VANTAGE VISION CARE QUAIL SPRINGS, PC
Entity Type:Organization
Organization Name:VANTAGE VISION CARE QUAIL SPRINGS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-847-6739
Mailing Address - Street 1:2501 W MEMORIAL RD STE 259A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-8021
Mailing Address - Country:US
Mailing Address - Phone:405-847-6739
Mailing Address - Fax:
Practice Address - Street 1:2501 W MEMORIAL RD STE 259A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-8021
Practice Address - Country:US
Practice Address - Phone:405-847-6739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty