Organization
FAMILY VISION CARE OF PONCA CITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY C CAMPBELL O.D. (OPTOMETRIST OWNER)
(580) 762-5700
Entity
Organization
Contact information
Practice address
1619 N 5TH ST, PONCA CITY, OK 74601-2703
(580) 762-5700
(580) 765-3022
Mailing address
1619 N 5TH ST, PONCA CITY, OK 74601-2703
(580) 762-5700
(580) 765-3022
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OK2144
OK
332B00000X
Durable Medical Equipment & Medical Supplies
OK2144
OK
332H00000X
Eyewear Supplier
OK2144
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100634170B
—
OK
Enumeration date
06/13/2007
Last updated
12/30/2016
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