Healthcare Provider Details

I. General information

NPI: 1851479737
Provider Name (Legal Business Name): NORTHWEST EYE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 MAIN ST
WOODWARD OK
73801-2938
US

IV. Provider business mailing address

PO BOX 1128
WOODWARD OK
73802-1128
US

V. Phone/Fax

Practice location:
  • Phone: 580-256-7755
  • Fax: 580-256-4819
Mailing address:
  • Phone: 580-256-7755
  • Fax: 580-256-4819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DAVID C JONES
Title or Position: PRESIDENT
Credential: O.D.
Phone: 580-256-7755