Healthcare Provider Details

I. General information

NPI: 1114161437
Provider Name (Legal Business Name): EYECARE OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 E 81ST ST 101
TULSA OK
74133-4556
US

IV. Provider business mailing address

10010 E 81ST ST 101
TULSA OK
74133-4556
US

V. Phone/Fax

Practice location:
  • Phone: 918-250-4554
  • Fax: 918-307-1943
Mailing address:
  • Phone: 918-250-4554
  • Fax: 918-307-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number2447
License Number StateOK

VIII. Authorized Official

Name: MS. MEGAN M FORD
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 918-250-2020