Organization
VISION SOURCE OF HUGO, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GINNY M EDWARDS (OFFICE MANAGER)
(580) 326-3319
Entity
Organization
Contact information
Practice address
806 E JACKSON ST, HUGO, OK 74743-4222
(580) 326-3319
(580) 326-3310
Mailing address
806 E JACKSON ST, HUGO, OK 74743-4222
(580) 326-3319
(580) 326-3310
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2096
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100766690A
—
OK
01
—
P00331640
RAILROAD MEDICARE
OK
Enumeration date
03/29/2007
Last updated
04/24/2008
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