Heritage Park Vision Source
NPI #1851417117 in Midwest City, Oklahoma
Provider Information
- NPI Number
- 1851417117
- Entity Type
- Organization
- Organization Name
- Heritage Park Vision Source
- Primary Specialty
- Eyewear Supplier
- Enumeration Date
- Mar 21, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 6912 E RENO AVE
- Address 2
- SUITE 101
- City
- Midwest City
- State
- Oklahoma
- ZIP Code
- 73110-2162
- Phone
- (405) 732-2277
Authorized Official
- Name
- DR. RUSSELL LAVERTY, O.D.
- Title
- OPTOMETRIST
- Phone
- (405) 732-2277
Specialties & Taxonomy Codes
| Specialty |
|---|
| Eyewear Supplier |
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