Organization Name: | POTEAU VISION SOURCE, PC |
NPI Number: | 1003036716 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TAMATHA KAY HOLT (PRESIDENT) |
Mailing Address: | 2203-b N. Broadway Poteau |
State: | OK US |
Postal Code: | 74953 |
Phone Number: | 9186490524 |
Fax Number: | 9186490891 |
NPI Enumeration Date: | 04/26/2007 |
NPI Last Update Date: | 06/17/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332H00000X |
License Number: | 2148 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
Taxonomy Specialization: | |
Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |