Provider Demographics
NPI:1851408215
Name:RICK L VISOR MD PC
Entity Type:Organization
Organization Name:RICK L VISOR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VISOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-755-6475
Mailing Address - Street 1:4140 W MEMORIAL RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8366
Mailing Address - Country:US
Mailing Address - Phone:405-755-6475
Mailing Address - Fax:405-755-8370
Practice Address - Street 1:4140 W MEMORIAL RD
Practice Address - Street 2:SUITE 115
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8366
Practice Address - Country:US
Practice Address - Phone:405-755-6475
Practice Address - Fax:405-755-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20577174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200101070AMedicaid
OK200101070AMedicaid
F09711Medicare UPIN