Seniorvision of Oklahoma LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

SENIORVISION OF OKLAHOMA LLC

Practice address

10107 S Garnett Rd
Broken Arrow, OK 74011-1118

Phone

(918) 252-0590

Fax

(918) 252-0591

NPI assigned

Oct 16, 2018

Organization subpart

No

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

Authorized official

Name

Nancy Kolker

Title

Vice President

Phone

(918) 298-4969

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Practitioners 1

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

• David Robert Kolker, O.D.

  • Optometrist
  • Tulsa, OK
  • NPI 1073618211

  OK

  Medicare reassignment

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

{
    "created_epoch": "1539648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1861968992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11063D S MEMORIAL DR # 515",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741337362",
            "telephone_number": "918-298-4969",
            "fax_number": "918-298-4594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10107 S GARNETT RD",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740111118",
            "telephone_number": "918-252-0590",
            "fax_number": "918-252-0591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIORVISION OF OKLAHOMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-16",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "KOLKER",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "918-298-4969"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100765700A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gerald Seefeldt, M.D.
• Gregory D Segraves, D.D.S., M.S.
• Zelda Faith Sellen, PHD
• Loren Sells
• Senior Citizens Nursing Center, Inc.
• Serenity Home Care LLC
• Serenity'S Baby Spa
• Taroniar Sevathas, DMD
• Narumi Shah, PT
• Terri Ann Shaleen

• All providers in Broken Arrow, OK
• Optometrist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.