Provider Demographics
NPI:1114161437
Name:EYECARE OPTICAL, LLC
Entity Type:Organization
Organization Name:EYECARE OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-250-2020
Mailing Address - Street 1:10010 E 81ST ST
Mailing Address - Street 2:101
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4556
Mailing Address - Country:US
Mailing Address - Phone:918-250-4554
Mailing Address - Fax:918-307-1943
Practice Address - Street 1:10010 E 81ST ST
Practice Address - Street 2:101
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4556
Practice Address - Country:US
Practice Address - Phone:918-250-4554
Practice Address - Fax:918-307-1943
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYECARE ASSOCIATES OF SOUTH TULSA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-30
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2447332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1114161437OtherNPI
OK200251660BMedicaid
OK1114161437OtherNPI