Healthcare Provider Details

I. General information

NPI: 1831318633
Provider Name (Legal Business Name): EYE CARE ASSOCIATES OF YUKON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 PROFESSIONAL CIR
YUKON OK
73099-6314
US

IV. Provider business mailing address

1604 PROFESSIONAL CIR
YUKON OK
73099-6314
US

V. Phone/Fax

Practice location:
  • Phone: 405-354-3624
  • Fax: 405-350-7512
Mailing address:
  • Phone: 405-354-3624
  • Fax: 405-350-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1109
License Number StateOK

VIII. Authorized Official

Name: DR. JASON MYERS
Title or Position: OWNER
Credential: O.D.
Phone: 405-354-3624