Organization
PEDIATRIC OPHTHALMOLOGY, PC
Active
Other names
Pediatric and Family Eyeware
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY THANE DENSLOW MD (PRESIDENT)
(918) 949-9898
Entity
Organization
Contact information
Practice address
4606 E 67TH ST, SUITE 400, TULSA, OK 74136-4943
(918) 481-2738
(918) 481-2785
Mailing address
4606 E 67TH ST STE 400, TULSA, OK 74136-4950
(918) 986-8585
(918) 728-8492
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
038654
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100735860B
—
OK
Enumeration date
08/31/2006
Last updated
01/23/2020
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