Provider Demographics
NPI:1700911542
Name:KOLKER VISION CARE
Entity Type:Organization
Organization Name:KOLKER VISION CARE
Other - Org Name:DAVID R KOLKER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOLKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-592-2020
Mailing Address - Street 1:5910 S LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7112
Mailing Address - Country:US
Mailing Address - Phone:918-592-2020
Mailing Address - Fax:918-743-8102
Practice Address - Street 1:5910 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7112
Practice Address - Country:US
Practice Address - Phone:918-592-2020
Practice Address - Fax:918-743-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1110152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9185922020OtherVSP
OK447729031003OtherBCBS OF OK
4305OtherSUPERIOR VISION
917671OtherEYEMED
OK447729031003OtherBCBS OF OK