Organization
GREAT PLAINS VISION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOBY J DEWALD OD (OPTOMETRIST / OWNER)
(580) 256-6699
Entity
Organization
Contact information
Practice address
1418 MAIN ST, WOODWARD, OK 73801-3004
(580) 256-6699
(580) 256-6706
Mailing address
PO BOX 2484, WOODWARD, OK 73802-2484
(580) 256-6699
(580) 256-6706
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2647
OK
Other
Enumeration date
05/11/2011
Last updated
09/21/2012
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