Provider Demographics
NPI:1982940508
Name:MID-DEL VISION SOURCE, PLLC
Entity type:Organization
Organization Name:MID-DEL VISION SOURCE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST. DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRICKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-732-2277
Mailing Address - Street 1:2008 S POST RD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-6610
Mailing Address - Country:US
Mailing Address - Phone:405-732-2277
Mailing Address - Fax:405-737-4776
Practice Address - Street 1:2008 S POST RD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-6610
Practice Address - Country:US
Practice Address - Phone:405-732-2277
Practice Address - Fax:405-737-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK318385Medicare PIN