Healthcare Provider Details

I. General information

NPI: 1154088961
Provider Name (Legal Business Name): MEB, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 S MAIN ST
GROVE OK
74344-2801
US

IV. Provider business mailing address

PO BOX 451627
GROVE OK
74345-1627
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-2254
  • Fax:
Mailing address:
  • Phone: 918-373-2167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RAMIE BARNES
Title or Position: MANAGING PROVIDER
Credential: OD
Phone: 918-373-2167