Healthcare Provider Details

I. General information

NPI: 1477732782
Provider Name (Legal Business Name): MAYER EYE CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 N 4TH ST STE C
PONCA CITY OK
74601-2745
US

IV. Provider business mailing address

1722 N 4TH ST STE C
PONCA CITY OK
74601-2745
US

V. Phone/Fax

Practice location:
  • Phone: 580-762-0870
  • Fax: 580-762-0871
Mailing address:
  • Phone: 580-762-0870
  • Fax: 580-762-0871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number2343
License Number StateOK

VIII. Authorized Official

Name: DR. TATYANA VICTORIA MAYER
Title or Position: PRESIDENT
Credential: OD
Phone: 580-762-0870