Individual provider · NPI-1

Ethan Paul Adre

Ophthalmology · Oklahoma City, OK

NPI number1750024634
StatusActive
Last updated in NPPESSep 23, 2024

Details

NPI
1750024634
Entity type
Individual (NPI-1)
Name
Ethan Paul Adre
Sex
Male
Sole proprietor
No
Enumeration date
Apr 18, 2022
Certification date
Sep 23, 2024
Last updated
Sep 23, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207W00000X Ophthalmology39396OKYes

Practice location

608 Stanton L Young Blvd
Oklahoma City, OK 73104-5014

Phone 405-271-7816

Mailing address

608 Stanton L Young Blvd
Oklahoma City, OK 73104-5014

Phone 405-271-7816

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