Healthcare Provider Details

I. General information

NPI: 1679290829
Provider Name (Legal Business Name): EYE ASSOCIATES OF OKLAHOMA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 S TELEPHONE RD
MOORE OK
73160-2937
US

IV. Provider business mailing address

1455 S DOUGLAS BLVD STE D
MIDWEST CITY OK
73130-5269
US

V. Phone/Fax

Practice location:
  • Phone: 405-799-7510
  • Fax: 405-438-0891
Mailing address:
  • Phone: 405-733-4545
  • Fax: 405-733-2758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH PRAVOOT GIRA
Title or Position: MD
Credential:
Phone: 314-909-0633