Provider Demographics
NPI:1386615128
Name:WISE, JAMES BERRY (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BERRY
Last Name:WISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 NW 56TH ST
Mailing Address - Street 2:STE #1010 A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4442
Mailing Address - Country:US
Mailing Address - Phone:405-945-4747
Mailing Address - Fax:405-945-4748
Practice Address - Street 1:3435 NW 56TH ST
Practice Address - Street 2:STE #1010 A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4442
Practice Address - Country:US
Practice Address - Phone:405-945-4747
Practice Address - Fax:405-945-4748
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8282207W00000X
OKAW2160024207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK8282OtherSTATE LICENSE
OKAW2160024OtherDEA #
OKAW2160024OtherDEA #