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General NPI Number Information
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NPI Number | 1770773277
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY EYE CARE INC
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 05/13/2009
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Provider Practice Location Address
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Address Line | 11319 SOUTH STATE HIGHWAY 51 SUITE 700
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City | COWETA
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State | OK
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Zip | 74429
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Country | US
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Telephone | 918-279-8830
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Fax |
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Provider Business Mailing Address
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Address Line | 9543 N 35TH ST E
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City | WAGONER
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State | OK
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Zip | 74467-8127
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Country | US
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Telephone | 918-260-8870
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFRY ALAN ROSS
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Credential | O.D.
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Telephone | 918-279-8830
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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 | 2541
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License Number State | OK
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