Organization
ENVISION MEDICAL & SURGICAL EYE CARE PC
Active
Organization
ENVISION MEDICAL & SURGICAL EYE CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIRANDA KIRSTEN RENFROW D.O. (PRESIDENT)
(918) 605-7456
Entity
Organization
Contact information
Practice address
4926 W KENOSHA ST, BROKEN ARROW, OK 74012-8517
(918) 605-7456
(918) 893-1724
Mailing address
4926 W KENOSHA ST, BROKEN ARROW, OK 74012-8517
(918) 605-7456
(918) 893-1724
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4949
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OKA102502
MEDICARE PTAN
OK
Enumeration date
06/22/2016
Last updated
06/22/2016
Update your record
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