Healthcare Provider Details

I. General information

NPI: 1699920397
Provider Name (Legal Business Name): CLAREMORE PRYOR EYE CLINIC P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 NE 1ST ST
PRYOR OK
74361-4014
US

IV. Provider business mailing address

1020 NE 1ST ST
PRYOR OK
74361-4014
US

V. Phone/Fax

Practice location:
  • Phone: 918-825-4427
  • Fax:
Mailing address:
  • Phone: 918-825-4427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DAVID REINECKE
Title or Position: OWNER
Credential: M.D.
Phone: 918-342-4222