Healthcare Provider Details

I. General information

NPI: 1194053660
Provider Name (Legal Business Name): IDEAL EYE CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2009
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 24TH AVE SW
NORMAN OK
73069-5110
US

IV. Provider business mailing address

444 24TH AVE SW
NORMAN OK
73069-5110
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-2020
  • Fax: 405-364-2021
Mailing address:
  • Phone: 405-364-2020
  • Fax: 405-364-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2605
License Number StateOK

VIII. Authorized Official

Name: DR. ANNA HUGHES
Title or Position: PRESIDENT
Credential: O.D.
Phone: 405-364-2020