Provider Demographics
NPI:1942605324
Name:ALLIANCE VISION SERVICES PLLC
Entity Type:Organization
Organization Name:ALLIANCE VISION SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BARTHOLOMEW
Authorized Official - Last Name:RAUPE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-815-6703
Mailing Address - Street 1:2816 W IMPERIAL ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-6461
Mailing Address - Country:US
Mailing Address - Phone:918-815-6703
Mailing Address - Fax:
Practice Address - Street 1:2816 W IMPERIAL ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-6461
Practice Address - Country:US
Practice Address - Phone:918-815-6703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2707152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty