MEDICARE: EYECARE ASSOCIATES OF SOUTH TULSA 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	2147	OK
2	207W00000X	Ophthalmology Physician	4088	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	500522178	OTHER	OK	MEDICARE
4	DF5413	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
2	6708040001	OTHER	OK	DMEMACS

General Provider Information

NPI Number	:	1750475760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYECARE ASSOCIATES OF SOUTH TULSA PC

Provider Business Mailing Address
First Line	:	10010 E 81ST ST STE 100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-4558
Country	:	US
Telephone Number	:	918-250-2020
Fax Number	:	918-250-8910

Provider Business Practice Location Address
First Line	:	10010 E 81ST ST STE 100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-4558
Country	:	US
Telephone Number	:	918-250-2020
Fax Number	:	918-250-8910

Authorized Official
Title or Position	:	ADMINISTRATION
Name	:	KRISTY PHILLIPS
Credential	:
Telephone Number	:	918-250-2020

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/10/2025

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Directions to “EYECARE ASSOCIATES OF SOUTH TULSA PC ” Practice Location

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