Provider Demographics
NPI:1831241587
Name:SYLVESTER, CARL L (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:L
Last Name:SYLVESTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 96-0392
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0392
Mailing Address - Country:US
Mailing Address - Phone:405-778-8993
Mailing Address - Fax:405-778-8994
Practice Address - Street 1:13321 N MERIDIAN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8356
Practice Address - Country:US
Practice Address - Phone:405-778-8993
Practice Address - Fax:405-778-8994
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23324174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00342407 CS5077OtherRR MEDICARE
OK731434343OtherTAX ID#
OK731434343OtherTAX ID#
OKP00342407 CS5077OtherRR MEDICARE