Organization
ADA VISION SOURCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES KEVIN CUNNINGHAM O.D. (OWNER)
(580) 332-3936
Entity
Organization
Contact information
Practice address
700 E MAIN ST, ADA, OK 74820-5614
(580) 332-3936
Mailing address
700 E MAIN ST, ADA, OK 74820-5614
(580) 332-3936
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OK2031
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100761700A
—
OK
01
—
440761954001
BLUE CROSS & BLUE SHIELD
OK
Enumeration date
07/11/2007
Last updated
06/21/2018
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