Provider Demographics
NPI:1295868941
Name:DRUMMOND OPTICAL, LLC
Entity type:Organization
Organization Name:DRUMMOND OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DRUMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-743-0110
Mailing Address - Street 1:424 S KNOBLOCK ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-3024
Mailing Address - Country:US
Mailing Address - Phone:405-743-0110
Mailing Address - Fax:405-743-0111
Practice Address - Street 1:424 S KNOBLOCK ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-3024
Practice Address - Country:US
Practice Address - Phone:405-743-0110
Practice Address - Fax:405-743-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1275910001Medicare NSC