Provider Demographics
NPI:1376659417
Name:NORMAN VISION CLINIC PLLC
Entity type:Organization
Organization Name:NORMAN VISION CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:FLAX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-321-2155
Mailing Address - Street 1:2501 BOARDWALK
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6372
Mailing Address - Country:US
Mailing Address - Phone:405-321-2155
Mailing Address - Fax:405-321-1170
Practice Address - Street 1:2501 BOARDWALK
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6372
Practice Address - Country:US
Practice Address - Phone:405-321-2155
Practice Address - Fax:405-321-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1007646450AMedicaid
OK1007646450AMedicaid