Provider Demographics
NPI:1699433508
Name:CHARLES VANAKI LLC
Entity type:Organization
Organization Name:CHARLES VANAKI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:VANAKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-249-4498
Mailing Address - Street 1:1303 LEO RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-5829
Mailing Address - Country:US
Mailing Address - Phone:405-249-4498
Mailing Address - Fax:
Practice Address - Street 1:2200 W DANFORTH RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-4602
Practice Address - Country:US
Practice Address - Phone:405-249-4498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty