Provider Demographics
NPI:1215245014
Name:RETINA CONSULTANTS OF OKLAHOMA PLLC
Entity type:Organization
Organization Name:RETINA CONSULTANTS OF OKLAHOMA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:V
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-691-0505
Mailing Address - Street 1:3366 NW EXPRESSWAY STE 670
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4416
Mailing Address - Country:US
Mailing Address - Phone:405-691-0505
Mailing Address - Fax:405-691-0507
Practice Address - Street 1:9821 S MAY AVE STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7042
Practice Address - Country:US
Practice Address - Phone:405-691-0505
Practice Address - Fax:405-691-0507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27666207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty