Provider Demographics
NPI:1255471629
Name:TULSA EYE ASSOCIATES OPTICAL INC
Entity Type:Organization
Organization Name:TULSA EYE ASSOCIATES OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:RONK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-493-7337
Mailing Address - Street 1:6465 S YALE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7823
Mailing Address - Country:US
Mailing Address - Phone:918-493-7337
Mailing Address - Fax:918-494-0700
Practice Address - Street 1:6465 S YALE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7823
Practice Address - Country:US
Practice Address - Phone:918-493-7337
Practice Address - Fax:918-494-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5701930001Medicare ID - Type Unspecified