MEDICARE: K. DEAN EVANS JR., OD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1175	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410049799	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235116898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K. DEAN EVANS JR., OD PC

Provider Business Mailing Address
First Line	:	113 N HIGHWAY 18
Second Line	:
City	:	CHANDLER
State	:	OK
Zip	:	74834-1200
Country	:	US
Telephone Number	:	405-258-1234
Fax Number	:	405-258-1236

Provider Business Practice Location Address
First Line	:	113 N HIGHWAY 18
Second Line	:
City	:	CHANDLER
State	:	OK
Zip	:	74834-1200
Country	:	US
Telephone Number	:	405-258-1234
Fax Number	:	405-258-1236

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KARL DEAN EVANS JR.
Credential	:	OD
Telephone Number	:	405-258-1234

Provider Enumeration Date	:	12/26/2005
Last Update Date	:	01/08/2015

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