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General NPI Number Information
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NPI Number | 1881778355
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Entity Type | Organization
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Legal Business Name | EYE ASSOCIATES OF MIAMI, INC.
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 2222 N MAIN ST
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City | MIAMI
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State | OK
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Zip | 74354-1619
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Country | US
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Telephone | 918-542-1929
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Fax | 918-542-7796
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Provider Business Mailing Address
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Address Line | 2222 N MAIN ST
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City | MIAMI
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State | OK
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Zip | 74354-1619
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Country | US
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Telephone | 918-542-1929
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Fax | 918-542-7796
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | WADE WALLS
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Credential | O.D.
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Telephone | 918-542-1929
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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 |
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License Number State |
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