Healthcare Provider Details

I. General information

NPI: 1487958492
Provider Name (Legal Business Name): MY FAMILY EYECARE, LTD., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 STATELINE RD
COLCORD OK
74338-1348
US

IV. Provider business mailing address

820 STATELINE RD
COLCORD OK
74338-1348
US

V. Phone/Fax

Practice location:
  • Phone: 918-422-5811
  • Fax: 918-422-5709
Mailing address:
  • Phone: 918-422-5811
  • Fax: 918-422-5709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2026
License Number StateOK

VIII. Authorized Official

Name: DR. SUSAN A VAUGHAN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 918-422-5811