Individual
JOHN R DIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4606 E. 67TH ST, SUITE 400, BLDG. #7, TULSA, OK 74136
(918) 949-9898
(918) 728-8091
Mailing address
4606 E. 67TH ST, SUITE 400, BLDG. #7, TULSA, OK 74136
(918) 949-9898
(918) 728-8091
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2726
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200498350A
—
OK
Enumeration date
06/03/2013
Last updated
01/22/2019
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