Organization
CHICKASAW NATION DIVISION OF HEALTH
Active
Other names
Oklahoma Optical
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD SHANE BOATRIGHT (OKLAHOMA OPTICAL MANAGER)
(580) 332-2796
Entity
Organization
Contact information
Practice address
1005 N COUNTRY CLUB RD, ADA, OK 74820-2847
(580) 332-2796
(580) 421-4523
Mailing address
1005 N COUNTRY CLUB RD, ADA, OK 74820-2847
(580) 332-2796
(580) 332-3360
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100768150A
—
OK
Enumeration date
08/29/2006
Last updated
12/04/2015
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