Healthcare Provider Details

I. General information

NPI: 1255655726
Provider Name (Legal Business Name): TEXOMA REGIONAL EYE INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5389 N 1ST AVE
DURANT OK
74701-2599
US

IV. Provider business mailing address

5389 N 1ST AVE
DURANT OK
74701-2599
US

V. Phone/Fax

Practice location:
  • Phone: 580-924-2712
  • Fax:
Mailing address:
  • Phone: 580-924-2712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN WALLACE CROFT
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 580-924-5211