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Northeastern State University College of Optometry

Optometrist in Tahlequah, OK · enumerated 2006 · authorized official Douglas Penisten, Dean.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1437106333

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Registry record

Entity type Organization (Type 2)
Legal business name Northeastern State University College of Optometry
Other name <Unavail>
Practice address 1001 N Grand Ave, Tahlequah, OK, 74464
Phone (918) 458-2109
Fax (918) 458-2310
Enumeration date May 27, 2006
Last updated in NPPES Aug 30, 2010

Taxonomy & classification

152W00000X Optometrist Eye and Vision Services Providers Primary
152WC0802X Corneal and Contact Management Optometrist Eye and Vision Services Providers Secondary
152WL0500X Low Vision Rehabilitation Optometrist Eye and Vision Services Providers Secondary
152WP0200X Pediatric Optometrist Eye and Vision Services Providers Secondary
152WS0006X Sports Vision Optometrist Eye and Vision Services Providers Secondary
152WV0400X Vision Therapy Optometrist Eye and Vision Services Providers Secondary
152WX0102X Occupational Vision Optometrist Eye and Vision Services Providers Secondary
207W00000X Ophthalmology Physician Allopathic & Osteopathic Physicians Secondary
332H00000X Eyewear Supplier Suppliers Secondary

Authorized official

Name Douglas Penisten
Title Dean
Phone (918) 456-5511

Other identifiers

Identifier Type State Issuer
100732440A Medicaid OK -

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

Who is the authorized official for Northeastern State University College of Optometry?
NPPES lists Douglas Penisten (Dean) as the authorized official for this organization.
What is the NPI number for Northeastern State University College of Optometry?
The NPI for Northeastern State University College of Optometry is 1437106333, a Type 2 (organization) record in the CMS NPPES registry.

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2010-08-30.