Provider Demographics
NPI:1285338053
Name:HARVARD OPTICAL, LLC
Entity type:Organization
Organization Name:HARVARD OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-747-3937
Mailing Address - Street 1:2000 SOUTH WHEELING AVENUE
Mailing Address - Street 2:STE 900
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104
Mailing Address - Country:US
Mailing Address - Phone:918-747-3937
Mailing Address - Fax:918-748-8707
Practice Address - Street 1:1661 SOUTH HARVARD AVENUE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112
Practice Address - Country:US
Practice Address - Phone:918-748-3620
Practice Address - Fax:918-748-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier