Organization
EYECARE BOULEVARD, P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MY DINH O.D. (OPTOMETRIST)
(405) 473-2899
Entity
Organization
Contact information
Practice address
7314 N WESTERN AVE, OKLAHOMA CITY, OK 73116-7120
(405) 437-0763
(405) 437-0764
Mailing address
9777 N COUNCIL RD, APT 1124, OKLAHOMA CITY, OK 73162-5500
(405) 473-2899
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2773
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200751820A
—
OK
Enumeration date
02/11/2017
Last updated
07/09/2018
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