Organization
JOHN B. MINNETT, O.D. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTEN ROBERSON CLIFT O.D. (PRESIDENT/OWNER)
(405) 224-5342
Entity
Organization
Contact information
Practice address
619 W CHICKASHA AVE, CHICKASHA, OK 73018-2413
(405) 224-5342
(405) 222-2819
Mailing address
619 W CHICKASHA AVE, P.O. BOX 1599, CHICKASHA, OK 73018-2413
(405) 224-5342
(405) 222-2819
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2155
OK
152WC0802X
Corneal and Contact Management Optometrist
2155
OK
152WP0200X
Pediatric Optometrist
2155
OK
332H00000X
Eyewear Supplier
2155
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100732660A
—
OK
01
—
410017130
RAILROAD MEDICARE
—
Enumeration date
07/10/2007
Last updated
02/09/2012
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