Healthcare Provider Details

I. General information

NPI: 1164099586
Provider Name (Legal Business Name): EASTLAND EYE CARE ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10651 E 31ST ST
TULSA OK
74146-1602
US

IV. Provider business mailing address

10651 E 31ST ST
TULSA OK
74146-1602
US

V. Phone/Fax

Practice location:
  • Phone: 918-437-6360
  • Fax: 918-437-6362
Mailing address:
  • Phone: 918-437-6360
  • Fax: 918-437-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. AARON M SCAVEZZE
Title or Position: OWNER
Credential: OD
Phone: 918-437-6360