1427051408 NPI number — BRITTON VISION ASSOCIATES INC

Table of content: (NPI 1427051408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427051408 NPI number — BRITTON VISION ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRITTON VISION ASSOCIATES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BVA ADVANCED EYECARE AND RETINA VITREOUS AFFILIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427051408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14701 N SANTA FE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73013-3411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-752-2733
Provider Business Mailing Address Fax Number:
405-752-2172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14701 N SANTA FE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73013-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-752-2733
Provider Business Practice Location Address Fax Number:
405-752-2172
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BRITTON
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
DON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
405-752-2733

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  NONE , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100708300C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100708300D , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100708300E , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100708300J , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100708300H , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100708300I , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100708300G , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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