Provider Demographics
NPI:1336332113
Name:NORTHWEST EYE PHYSICIANS INC
Entity Type:Organization
Organization Name:NORTHWEST EYE PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:H
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:405-943-4413
Mailing Address - Street 1:5600 N. PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2023
Mailing Address - Country:US
Mailing Address - Phone:405-943-4413
Mailing Address - Fax:405-942-0115
Practice Address - Street 1:5600 N. PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2023
Practice Address - Country:US
Practice Address - Phone:405-943-4413
Practice Address - Fax:405-942-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100729600AMedicaid
OK400522249Medicare PIN