Provider Demographics
NPI:1750465340
Name:OKLAHOMA RETINA PLLC
Entity type:Organization
Organization Name:OKLAHOMA RETINA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:SROUJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-443-3350
Mailing Address - Street 1:3520 NW 58TH ST STE A100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4407
Mailing Address - Country:US
Mailing Address - Phone:405-443-3350
Mailing Address - Fax:405-443-3341
Practice Address - Street 1:3520 NW 58TH ST STE A100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4407
Practice Address - Country:US
Practice Address - Phone:405-443-3350
Practice Address - Fax:405-443-3341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200071590AMedicaid
448706812005OtherBLUE LINCS
448706812005OtherBCBS
731532364731120000OtherTRICARE
731532364731120000OtherTRICARE