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General NPI Number Information
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NPI Number | 1740459858
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Entity Type | Organization
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Legal Business Name | SCOTT K. MCEACHERN, O.D.
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 1220 W WILLOW RD SUITE B
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City | ENID
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State | OK
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Zip | 73703-2511
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Country | US
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Telephone | 580-237-4772
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Fax | 580-237-4841
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Provider Business Mailing Address
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Address Line | 1220 W WILLOW RD SUITE B
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City | ENID
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State | OK
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Zip | 73703-2511
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Country | US
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Telephone | 580-237-4772
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Fax | 580-237-4841
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOTT K. MCEACHERN
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Credential | O.D.
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Telephone | 580-237-4772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 2138
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License Number State | OK
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