Active NPI
George Mark Redwine, O.D.
- Optometrist
- Oklahoma City, OK
National Provider Identifier
1235109232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 822
- Practice address
- 4720 N Classen Blvd
Oklahoma City, OK 73118-4827 - Phone
- (405) 528-1207
- Fax
- (405) 528-0279
- NPI assigned
- Jan 24, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 822 | OK | Primary |
Addresses
Primary practice location
4720 N Classen Blvd
Oklahoma City, OK 73118-4827
Mailing address
4720 N Classen Blvd
Oklahoma City, OK 73118-4827
Phone (405) 528-1207
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100765430A | 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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260921600000",
"number": "1235109232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4720 N CLASSEN BLVD",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731184827",
"telephone_number": "405-528-1207",
"fax_number": "405-528-0279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4720 N CLASSEN BLVD",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731184827",
"telephone_number": "405-528-1207",
"fax_number": "405-528-0279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REDWINE",
"first_name": "GEORGE",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-24",
"last_updated": "2009-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OK",
"license": "822",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100765430A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.