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Organization

SHAWNEE EYE ASSOCIATES, PLLC

Active
Other names
Shawnee Vision Source
Organization subpart
No

Provider details

NPI number
Authorized official
DR. TREVOR CONKLIN MD (OWNER/PARTNER)
(405) 275-7676
Entity
Organization

Contact information

Practice address
100 E 45TH ST, SHAWNEE, OK 74804-1439
(405) 275-7676
(405) 275-6837
Mailing address
100 E 45TH ST, SHAWNEE, OK 74804-1439
(405) 275-7676
(405) 275-6837

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2690
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200350320A
OK
Enumeration date
09/22/2014
Last updated
09/22/2014
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