Healthcare Provider Details

I. General information

NPI: 1750475760
Provider Name (Legal Business Name): EYECARE ASSOCIATES OF SOUTH TULSA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 E 81ST ST STE 100
TULSA OK
74133-4558
US

IV. Provider business mailing address

10010 E 81ST ST STE 100
TULSA OK
74133-4558
US

V. Phone/Fax

Practice location:
  • Phone: 918-250-2020
  • Fax: 918-250-8910
Mailing address:
  • Phone: 918-250-2020
  • Fax: 918-250-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2147
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4088
License Number StateOK

VIII. Authorized Official

Name: KRISTY PHILLIPS
Title or Position: ADMINISTRATION
Credential:
Phone: 918-250-2020