Healthcare Provider Details

I. General information

NPI: 1245309095
Provider Name (Legal Business Name): SCOTT EYE CARE P L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S MAIN ST
SHATTUCK OK
73858
US

IV. Provider business mailing address

PO BOX 770
SHATTUCK OK
73858-0770
US

V. Phone/Fax

Practice location:
  • Phone: 580-938-5210
  • Fax: 580-938-2166
Mailing address:
  • Phone: 580-938-5210
  • Fax: 580-938-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2374
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID C JONES
Title or Position: SOLE MEMBER
Credential: O.D.
Phone: 580-938-5210