MEDICARE: EYE CARE SERVICES

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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1538495577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CARE SERVICES

Provider Business Mailing Address
First Line	:	3431 S BOULEVARD ST
Second Line	:	SUITE 106
City	:	EDMOND
State	:	OK
Zip	:	73013-5475
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S VERMONT AVE
Second Line	:	SUITE 125
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73108-1017
Country	:	US
Telephone Number	:	405-947-1066
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DARLENE STROUT
Credential	:
Telephone Number	:	405-562-2036

Provider Enumeration Date	:	10/27/2009
Last Update Date	:	10/27/2009

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