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Grand Lake Optical, LLC

NPI #1649383191 in Grove, Oklahoma

Provider Information

NPI Number
1649383191
Entity Type
Organization
Organization Name
Grand Lake Optical, LLC
Primary Specialty
Eyewear Supplier
Enumeration Date
Aug 17, 2006
Last Updated
Nov 18, 2010

Practice Location

Address
1120 NEO LOOP
City
Grove
State
Oklahoma
ZIP Code
74344
Phone
(918) 787-2121

Authorized Official

Name
DR. KEVIN K TOLLER, MD
Title
PRESIDENT
Phone
(918) 787-2020

Specialties & Taxonomy Codes

Specialty
Eyewear Supplier

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