| Organization Name: | NORTHEASTERN STATE UNIVERSITY COLLEGE OF OPTOMETRY |
| NPI Number: | 1437106333 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DOUGLAS PENISTEN (DEAN) |
| Mailing Address: | 1001 N Grand Ave Tahlequah |
| State: | OK US |
| Postal Code: | 744647017 |
| Phone Number: | 9184582109 |
| Fax Number: | 9184582310 |
| NPI Enumeration Date: | 05/27/2006 |
| NPI Last Update Date: | 08/30/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332H00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| 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. |