Healthcare Provider Details

I. General information

NPI: 1225180557
Provider Name (Legal Business Name): EYE CARE OKLAHOMA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S TELEPHONE RD SUITE 101
MOORE OK
73160-5423
US

IV. Provider business mailing address

520 S TELEPHONE RD SUITE 101
MOORE OK
73160-5423
US

V. Phone/Fax

Practice location:
  • Phone: 405-799-7510
  • Fax: 405-799-4742
Mailing address:
  • Phone: 405-799-7510
  • Fax: 405-799-4742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number13242
License Number StateOK

VIII. Authorized Official

Name: DR. JAY E LEEMASTER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 405-799-7510