Healthcare Provider Details

I. General information

NPI: 1215520218
Provider Name (Legal Business Name): EYE CARE SURGERY CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 NW EXPRESSWAY STE 335
OKLAHOMA CITY OK
73132-1561
US

IV. Provider business mailing address

7101 NW EXPRESSWAY STE 335
OKLAHOMA CITY OK
73132-1561
US

V. Phone/Fax

Practice location:
  • Phone: 405-733-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUKE REBENITSCH
Title or Position: SURGEON
Credential: MD
Phone: 405-733-2020