MEDICARE: BRIGHT EYES FAMILY EYECARE, 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	152W00000X	Optometrist	2630	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	:	1912284167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT EYES FAMILY EYECARE, PLLC

Provider Business Mailing Address
First Line	:	9424 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2712
Country	:	US
Telephone Number	:	405-751-8851
Fax Number	:	405-751-5058

Provider Business Practice Location Address
First Line	:	9424 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2712
Country	:	US
Telephone Number	:	405-751-8851
Fax Number	:	405-751-5058

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	DR. BRYAN L WOMACK
Credential	:	OD
Telephone Number	:	405-751-8851

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	08/17/2020

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