Organization
EDMOND REGIONAL EYE ASSOCIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT D GOURLEY MD (OWNER OF PRACTICE)
(405) 341-4238
Entity
Organization
Contact information
Practice address
920 S BRYANT, STE 100, EDMOND, OK 73034
(405) 341-4238
Mailing address
920 S BRYANT, STE 100, EDMOND, OK 73034
(405) 341-4238
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CH6423
RR MEDICARE
—
Enumeration date
08/17/2006
Last updated
08/22/2020
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