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General NPI Number Information
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NPI Number | 1215064308
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Entity Type | Organization
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Legal Business Name | EYE CARE FOR TULSA INC.
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 3906 S PEORIA AVE
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City | TULSA
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State | OK
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Zip | 74105-3131
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Country | US
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Telephone | 918-585-1523
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Fax | 918-584-5520
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Provider Business Mailing Address
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Address Line | 3906 S PEORIA AVE
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City | TULSA
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State | OK
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Zip | 74105-3131
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Country | US
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Telephone | 918-585-1523
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Fax | 918-584-5520
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Authorized Official
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Title or Position | AR MANAGER
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Name | AMY MELLISSA JONES
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Credential |
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Telephone | 918-585-1523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1063
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1020
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2437
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 10268
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License Number State | OK
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