Healthcare Provider Details

I. General information

NPI: 1083743983
Provider Name (Legal Business Name): THOMAS BLUE EYECARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5113 SE 15TH ST
DEL CITY OK
73115-3952
US

IV. Provider business mailing address

5113 SE 15TH ST SUITE A
DEL CITY OK
73115-3952
US

V. Phone/Fax

Practice location:
  • Phone: 405-677-8831
  • Fax: 405-677-8865
Mailing address:
  • Phone: 405-677-8831
  • Fax: 405-677-8865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS DEAN BLUE
Title or Position: OWNER
Credential: OD
Phone: 405-677-8831