=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164619110
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TULSA EYE CONSULTANTS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2007
-----------------------------------------------------
Last Update Date | 01/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2448 E 81ST ST STE 3700
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74137-4257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-492-4122
-----------------------------------------------------
Fax | 918-492-7451
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2448 E 81ST ST STE 3700
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74137-4257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-492-4122
-----------------------------------------------------
Fax | 918-492-7451
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | CYNDI EAGLETON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-492-4122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZS0410X
-----------------------------------------------------
Taxonomy Name | Surgical Technologist
-----------------------------------------------------
License Number | 13121
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------