Provider Demographics
NPI:1073644720
Name:HUBERTINA J M HAGEN OD INC PC
Entity Type:Organization
Organization Name:HUBERTINA J M HAGEN OD INC PC
Other - Org Name:EYE TO EYE FAMILY VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-227-3937
Mailing Address - Street 1:1029 E TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-4570
Mailing Address - Country:US
Mailing Address - Phone:918-227-3937
Mailing Address - Fax:888-972-5679
Practice Address - Street 1:1029 E TAFT AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4570
Practice Address - Country:US
Practice Address - Phone:918-227-3937
Practice Address - Fax:888-972-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2243152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200124200AMedicaid