MEDICARE: TULSA EYE CENTER PLLC

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	156FX1800X	Optician
2	156FX1800X	Optician	13574	OK

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	:	1548486095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TULSA EYE CENTER PLLC

Provider Business Mailing Address
First Line	:	4815 S HARVARD AVE STE 210
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-3066
Country	:	US
Telephone Number	:	918-895-7855
Fax Number	:	918-745-9800

Provider Business Practice Location Address
First Line	:	4815 S HARVARD AVE STE 210
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-3066
Country	:	US
Telephone Number	:	918-895-7855
Fax Number	:	918-745-9800

Authorized Official
Title or Position	:	OWNER/PRES
Name	:	DR. MANEK E ANKLESARIA
Credential	:	MD
Telephone Number	:	918-745-9800

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	03/27/2019

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