Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 934 | OK |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 934 | OK |
NPI | 1104894088 |
---|---|
Provider Name | Mr. Robert Charles Duke |
First Address | Catoosa, OK 74015-0098 |
Second Address | Catoosa, OK 74015-2409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 01/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T40428 | (02) | OK |