MEDICARE: EYEQ VISION 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	152W00000X	Optometrist	OK2286	OK

General Provider Information

NPI Number	:	1992054225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEQ VISION CENTER PLLC

Provider Business Mailing Address
First Line	:	7519 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3203
Country	:	US
Telephone Number	:	405-286-2220
Fax Number	:	405-286-0317

Provider Business Practice Location Address
First Line	:	7519 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3203
Country	:	US
Telephone Number	:	405-286-2220
Fax Number	:	405-286-0317

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. STACEY ROCKETT
Credential	:	O.D.
Telephone Number	:	405-286-2220

Provider Enumeration Date	:	08/31/2012
Last Update Date	:	08/05/2014

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