Provider Demographics
NPI:1275802183
Name:PRECISION VISION SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:PRECISION VISION SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-636-1508
Mailing Address - Street 1:6922 S WESTERN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-1803
Mailing Address - Country:US
Mailing Address - Phone:405-636-1508
Mailing Address - Fax:405-636-1239
Practice Address - Street 1:6922 S WESTERN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1803
Practice Address - Country:US
Practice Address - Phone:405-636-1508
Practice Address - Fax:405-636-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0019261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical