Active NPI
Bruce Wayne Varner, O.D.
- Optometrist
- Pauls Valley, OK
National Provider Identifier
1194716019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- O.D. 902
- Practice address
- 100 Maxwell Dr
Pauls Valley, OK 73075-6812 - Phone
- (405) 238-6459
- Fax
- (405) 238-6450
- NPI assigned
- Oct 31, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | O.D. 902 | OK | Primary |
Addresses
Primary practice location
100 Maxwell Dr
Pauls Valley, OK 73075-6812
Mailing address
PO Box 622
Pauls Valley, OK 73075-0622
Phone (405) 238-6459
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100763600B | Medicaid | OK | |
| 100763600A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| O.D. 902 | OK | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye Doctors of Oklahoma Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Ophthalmology Physician
- Norman, OK
- NPI 1376853952
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210550400000",
"number": "1194716019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 622",
"city": "PAULS VALLEY",
"state": "OK",
"postal_code": "730750622",
"telephone_number": "405-238-6459",
"fax_number": "405-238-6450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MAXWELL DR",
"city": "PAULS VALLEY",
"state": "OK",
"postal_code": "730756812",
"telephone_number": "405-238-6459",
"fax_number": "405-238-6450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VARNER",
"first_name": "BRUCE",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-31",
"last_updated": "2008-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OK",
"license": "O.D. 902",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100763600B",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100763600A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pauls Valley, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.