MEDICARE: EYES LTD, 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	906	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OKA100551	OTHER	OK	GROUP PTAN

General Provider Information

NPI Number	:	1760674014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYES LTD, PC

Provider Business Mailing Address
First Line	:	6508 N WESTERN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7324
Country	:	US
Telephone Number	:	405-848-3937
Fax Number	:	405-840-5256

Provider Business Practice Location Address
First Line	:	6508 N. WESTERN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-4522
Country	:	US
Telephone Number	:	405-848-3937
Fax Number	:	405-840-5256

Authorized Official
Title or Position	:	OWNER
Name	:	C. SCOTT COWELL
Credential	:	OD
Telephone Number	:	405-848-3937

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	11/02/2010

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Directions to “EYES LTD, PC ” Practice Location

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