NPIMap

Organization Active NPI

Canadian Valley Vision Center, PC

  • Optometrist
  • Holdenville, OK
National Provider Identifier
1639329071
Registry record updated Jun 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2576 Issued in OK
Legal business name
CANADIAN VALLEY VISION CENTER, PC
Practice address
121 W Main St
Holdenville, OK 74848-3229
Phone
(405) 379-3610
Fax
(405) 379-2019
NPI assigned
Sep 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2009

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

Authorized official

Name
Martin D O'Donnell, O.D.
Title
President
Phone
(405) 379-3610

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 2576 OK Primary
Corneal and Contact Management OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WC0802X 2576 OK
Low Vision Rehabilitation OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WL0500X 2576 OK
Pediatric OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WP0200X 2576 OK

Addresses

Primary practice location

121 W Main St
Holdenville, OK 74848-3229

Mailing address

PO Box 897
Holdenville, OK 74848-0897
Phone (405) 379-3610

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1222128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246233600000",
    "number": "1639329071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 897",
            "city": "HOLDENVILLE",
            "state": "OK",
            "postal_code": "748480897",
            "telephone_number": "405-379-3610",
            "fax_number": "405-379-2019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 W MAIN ST",
            "city": "HOLDENVILLE",
            "state": "OK",
            "postal_code": "748483229",
            "telephone_number": "405-379-3610",
            "fax_number": "405-379-2019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANADIAN VALLEY VISION CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-23",
        "last_updated": "2009-06-29",
        "status": "A",
        "authorized_official_last_name": "O'DONNELL",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-379-3610",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2576",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "OK",
            "license": "2576",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "OK",
            "license": "2576",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": "OK",
            "license": "2576",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holdenville, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 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.

Verify at the official NPI Registry.