Individual
MARK B PRIVOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O. D.
Contact information
Practice address
4205 MCAULEY BLVD, OKLAHOMA CITY, OK 73120-8347
(405) 755-6111
(405) 755-6298
Mailing address
4205 MCAULEY BLVD, OKLAHOMA CITY, OK 73120-8347
(405) 755-6111
(405) 755-6298
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1113
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100759820A
—
OK
Enumeration date
09/02/2005
Last updated
04/16/2008
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