Wagoner Eye Clinic Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

2018 Issued in OK

Legal business name

WAGONER EYE CLINIC INC

Practice address

1108 W Cherokee St
Wagoner, OK 74467-4622

Phone

(918) 485-2123

Fax

(918) 485-4777

NPI assigned

Nov 13, 2006

Organization subpart

No

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

Authorized official

Name

Jeffrey Alan Mitchell, O.D.

Title

President

Phone

(918) 485-2123

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347580800000",
    "number": "1497826358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 W CHEROKEE ST",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744674622",
            "telephone_number": "918-485-2123",
            "fax_number": "918-485-4777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 W CHEROKEE ST",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744674622",
            "telephone_number": "918-485-2123",
            "fax_number": "918-485-4777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGONER EYE CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2012-09-14",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-485-2123",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100759760A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria Vo
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• Optometrist in Wagoner, OK
• Providers in Wagoner, OK by specialty
• Optometrist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2012; 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.