Organization
ROGER L RADELL O D INCORPORATED P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER LEE RADELL OD (PRESIDENT)
(405) 567-2261
Entity
Organization
Contact information
Practice address
915 9TH STREET, PRAGUE, OK 74864-0507
(405) 567-2261
Mailing address
PO BOX 507, PRAGUE, OK 74864-0507
(405) 567-2261
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2024
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275753550
NPI
—
05
—
200618310A
—
OK
Enumeration date
04/27/2007
Last updated
04/01/2016
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