Pediatric Ophthalmology, PC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

038654 Issued in OK

Legal business name

PEDIATRIC OPHTHALMOLOGY, PC

Practice address

4606 E 67TH St
Suite 400
Tulsa, OK 74136-4943

Phone

(918) 481-2738

Fax

(918) 481-2785

NPI assigned

Aug 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gary Thane Denslow, MDNPI 1194718775

Title

President

Phone

(918) 949-9898

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pediatric and Family Eyeware Doing business as

Electronic endpoints 1

Tax ID family

Pediatric and Family Eyecare2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pediatric Ophthalmology, PC

  • Pediatric Ophthalmology and Strabismus Specialist Physician
  • Tulsa, OK
  • NPI 1447244827
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gary Thane Denslow, M.D.

  • Ophthalmology Physician
  • Tulsa, OK
  • NPI 1194718775
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579737600000",
    "number": "1053423947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4606 E 67TH ST STE 400",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741364950",
            "telephone_number": "918-986-8585",
            "fax_number": "918-728-8492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4606 E 67TH ST",
            "address_2": "SUITE 400",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741364943",
            "telephone_number": "918-481-2738",
            "fax_number": "918-481-2785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC OPHTHALMOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A",
        "authorized_official_last_name": "DENSLOW",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "THANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-949-9898",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "OK",
            "license": "038654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100735860B",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Direct@PediatricEyeAssociatesAndFTulsaOK.CompulinkDirect.com",
            "affiliation": "N",
            "endpointDescription": "optical shop",
            "address_1": "4606 E 67th St",
            "address_2": "Suite 400",
            "city": "Tulsa",
            "state": "OK",
            "country_code": "US",
            "postal_code": "741364943",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Pediatric and Family Eyeware",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pediatric and Family Eyeware",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eyewear Supplier in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Eyewear Supplier in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.