Redwine, George Mark
Redwine, George Mark is an individual health care provider with primary practice located at 4720 N Classen Blvd , Oklahoma City OK 73118-4827. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Redwine, George Mark can be contacted via phone (405) 528-1207.Contact Information
Primary practice address
4720 N Classen Blvd
Oklahoma City OK 73118-4827
Phone: (405) 528-1207
Fax: (405) 528-0279
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 822 | Oklahoma |
Profile Details
| NPI number | 1235109232 |
|---|---|
| LBN Legal business name | Redwine, George Mark |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 24th, 2006 |
| Last updated | Dec 16th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1235109232 | NPPES |
| Oklahoma | MEDICAID | 100765430A |
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