Healthcare Provider Details

I. General information

NPI: 1053096321
Provider Name (Legal Business Name): OKLAHOMA EYE INSTITUTE PROCEDURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N MAIN ST
ELK CITY OK
73644-2831
US

IV. Provider business mailing address

1020 N MAIN ST
ELK CITY OK
73644-2831
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-1555
  • Fax:
Mailing address:
  • Phone: 580-225-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAMRAN MASSOUMI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 580-225-1555