Provider Demographics
NPI:1881745768
Name:MAX D. VENARD, O.D., P.C.
Entity type:Organization
Organization Name:MAX D. VENARD, O.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:D
Authorized Official - Last Name:VENARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-794-7544
Mailing Address - Street 1:705 CITY AVE
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3819
Mailing Address - Country:US
Mailing Address - Phone:405-794-7544
Mailing Address - Fax:405-794-7599
Practice Address - Street 1:705 CITY AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3819
Practice Address - Country:US
Practice Address - Phone:405-794-7544
Practice Address - Fax:405-794-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0932152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100744400AMedicaid
OK730942527002OtherBLUE CROSS BLUE SHIELD
OK100744400AMedicaid
OK700522052Medicare ID - Type UnspecifiedGROUP NUMBER
OK1041330001Medicare NSC