Healthcare Provider Details

I. General information

NPI: 1518889757
Provider Name (Legal Business Name): ID EYE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 N SANTA FE AVE STE 107
EDMOND OK
73013-2489
US

IV. Provider business mailing address

14201 N SANTA FE AVE STE 107
EDMOND OK
73013-2489
US

V. Phone/Fax

Practice location:
  • Phone: 405-498-2221
  • Fax: 405-303-1262
Mailing address:
  • Phone: 405-498-2221
  • Fax: 405-303-1262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: IRINA DANIEL
Title or Position: OWNER
Credential: OD
Phone: 214-274-9085