Provider Demographics
NPI:1235116898
Name:K. DEAN EVANS JR., OD PC
Entity Type:Organization
Organization Name:K. DEAN EVANS JR., OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:405-258-1234
Mailing Address - Street 1:113 N HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-1200
Mailing Address - Country:US
Mailing Address - Phone:405-258-1234
Mailing Address - Fax:405-258-1236
Practice Address - Street 1:113 N HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-1200
Practice Address - Country:US
Practice Address - Phone:405-258-1234
Practice Address - Fax:405-258-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-26
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1175152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100762700AMedicaid
OK410049799OtherRAILROAD MEDICARE
OKT40435Medicare UPIN
OK410049799OtherRAILROAD MEDICARE
OK=========001Medicare PIN