Provider Demographics
NPI:1083654842
Name:EYECARE OF CLAREMORE-CLAREMORE
Entity Type:Organization
Organization Name:EYECARE OF CLAREMORE-CLAREMORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:KUYKENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-341-2020
Mailing Address - Street 1:221 S FLORENCE AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-8221
Mailing Address - Country:US
Mailing Address - Phone:918-341-2020
Mailing Address - Fax:918-341-3888
Practice Address - Street 1:221 S FLORENCE AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-8221
Practice Address - Country:US
Practice Address - Phone:918-341-2020
Practice Address - Fax:918-341-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2161152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200091700AMedicaid
OK200091700AMedicaid
OKU58451Medicare UPIN
OK300522229Medicare PIN
OKDG0589Medicare PIN