Healthcare Provider Details

I. General information

NPI: 1790823300
Provider Name (Legal Business Name): EYE RESTORATION CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4606 S GARNETT RD #302
TULSA OK
74146-5231
US

IV. Provider business mailing address

4606 S GARNETT RD #302
TULSA OK
74146-5231
US

V. Phone/Fax

Practice location:
  • Phone: 918-664-6544
  • Fax: 918-664-0668
Mailing address:
  • Phone: 918-664-6544
  • Fax: 918-664-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberNON REQUIRED
License Number StateOK

VIII. Authorized Official

Name: MS. ELSIE M. JOY
Title or Position: OCULARIST
Credential: B.C.O.
Phone: 918-664-6544