Individual
DR. BRENT PLAXICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
12406 E 86TH ST N, OWASSO, OK 74055-2500
(918) 376-2700
Mailing address
12406 E 86TH ST N, 5201, OWASSO, OK 74055-2500
(918) 376-2700
(918) 376-2722
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1412
SC
152W00000X
Optometrist
Primary
2823
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A677
MEDICARE PTAN
SC
05
—
D14125
—
SC
Enumeration date
07/27/2006
Last updated
01/25/2016
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