MEDICARE: ELITE EYE CARE 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	2393	OK

General Provider Information

NPI Number	:	1720345465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE EYE CARE PC

Provider Business Mailing Address
First Line	:	1901 NW EXPRESSWAY
Second Line	:	SUITE 1082
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-1607
Country	:	US
Telephone Number	:	405-848-8845
Fax Number	:

Provider Business Practice Location Address
First Line	:	14524 BOGERT PKWY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-2629
Country	:	US
Telephone Number	:	405-848-8845
Fax Number	:	405-848-3570

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANITA DAWN LE
Credential	:	O.D.
Telephone Number	:	405-848-8845

Provider Enumeration Date	:	04/19/2012
Last Update Date	:	06/07/2022

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