Provider Demographics
NPI:1225647415
Name:LEGACY EYE CARE PLLC
Entity Type:Organization
Organization Name:LEGACY EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-207-6276
Mailing Address - Street 1:10001 ABERDEEN LN
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7644
Mailing Address - Country:US
Mailing Address - Phone:918-207-6276
Mailing Address - Fax:
Practice Address - Street 1:1207 CORNWELL DR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4633
Practice Address - Country:US
Practice Address - Phone:405-354-3384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty