Healthcare Provider Details

I. General information

NPI: 1700966959
Provider Name (Legal Business Name): SENIOR EYE CARE SERVICE OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3383 N MERIDIAN AVE
NEWCASTLE OK
73065-3634
US

IV. Provider business mailing address

117 WILLOW BRANCH RD
NORMAN OK
73072-4506
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-2454
  • Fax: 405-360-8650
Mailing address:
  • Phone: 405-360-9778
  • Fax: 405-360-8650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number167076
License Number StateOK

VIII. Authorized Official

Name: MR. CORNELIUS JEMEEL CARTER
Title or Position: OPTICIAN/OWNER
Credential: ABOC
Phone: 405-360-2454