=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699804062
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEYS FAMILY EYE CARE PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2007
-----------------------------------------------------
Last Update Date | 08/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24295 HIGHWAY 82 BUILDING 2
-----------------------------------------------------
City | PARK HILL
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74451-4012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-207-0700
-----------------------------------------------------
Fax | 918-207-0701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24295 HIGHWAY 82 BUILDING 2
-----------------------------------------------------
City | PARK HILL
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74451-4012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-207-0700
-----------------------------------------------------
Fax | 918-207-0701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. STEPHANIE MICHELLE RICE
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 91802070700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2400
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------