Provider Demographics
NPI:1073618211
Name:KOLKER, DAVID ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
Last Name:KOLKER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11711 S HUDSON PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-8530
Mailing Address - Country:US
Mailing Address - Phone:918-298-4969
Mailing Address - Fax:
Practice Address - Street 1:11711 S HUDSON PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-8530
Practice Address - Country:US
Practice Address - Phone:918-298-4969
Practice Address - Fax:918-298-4969
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1110152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100765700AMedicaid
238304601Medicare PIN
OK100765700AMedicaid