Provider Demographics
NPI:1003011511
Name:ENID EYE OPTICAL, INC.
Entity Type:Organization
Organization Name:ENID EYE OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SHEWEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-242-0511
Mailing Address - Street 1:615 E OKLAHOMA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5951
Mailing Address - Country:US
Mailing Address - Phone:580-242-0511
Mailing Address - Fax:580-242-0524
Practice Address - Street 1:615 E OKLAHOMA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5951
Practice Address - Country:US
Practice Address - Phone:580-242-0511
Practice Address - Fax:580-242-0524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0422730001Medicare ID - Type Unspecified