Provider Demographics
NPI:1346610375
Name:ADVANCED EYE SW 44TH LLC
Entity Type:Organization
Organization Name:ADVANCED EYE SW 44TH LLC
Other - Org Name:ADVANCED EYE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/OPHTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:BELARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-755-7700
Mailing Address - Street 1:1111 SW 44TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3601
Mailing Address - Country:US
Mailing Address - Phone:405-702-4302
Mailing Address - Fax:405-702-4310
Practice Address - Street 1:1111 SW 44TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3601
Practice Address - Country:US
Practice Address - Phone:405-702-4302
Practice Address - Fax:405-702-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty