Healthcare Provider Details

I. General information

NPI: 1285767848
Provider Name (Legal Business Name): ADA FAMILY EYE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 S TOWNSEND ST
ADA OK
74820-6429
US

IV. Provider business mailing address

309 S TOWNSEND ST
ADA OK
74820-6429
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-2020
  • Fax:
Mailing address:
  • Phone: 580-436-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOK2064
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOK2064
License Number StateOK

VIII. Authorized Official

Name: DR. STEVEN CHRISTOPHER GURLEY
Title or Position: PRESIDENT
Credential:
Phone: 580-436-2020