Provider Demographics
NPI:1235315987
Name:LEDBETTER EYECARE
Entity Type:Organization
Organization Name:LEDBETTER EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-794-3588
Mailing Address - Street 1:626 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3804
Mailing Address - Country:US
Mailing Address - Phone:405-794-3588
Mailing Address - Fax:405-794-0306
Practice Address - Street 1:626 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3804
Practice Address - Country:US
Practice Address - Phone:405-794-3588
Practice Address - Fax:405-794-0306
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEDBETTER EYECARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1180332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1320340001Medicare NSC