Provider Demographics
NPI:1164619110
Name:TULSA EYE CONSULTANTS, INC.
Entity Type:Organization
Organization Name:TULSA EYE CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:
Authorized Official - Last Name:EAGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-492-4122
Mailing Address - Street 1:6606 S YALE AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3376
Mailing Address - Country:US
Mailing Address - Phone:918-492-4122
Mailing Address - Fax:918-492-7451
Practice Address - Street 1:6606 S YALE AVE STE 220
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3376
Practice Address - Country:US
Practice Address - Phone:918-492-4122
Practice Address - Fax:918-492-7451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13121246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100089490AMedicaid
OK100089490AMedicaid