Provider Demographics
NPI:1427194976
Name:MCALESTER VISION CENTER INC
Entity Type:Organization
Organization Name:MCALESTER VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:DUFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-426-0106
Mailing Address - Street 1:PO BOX 1770
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74502-1770
Mailing Address - Country:US
Mailing Address - Phone:918-426-0106
Mailing Address - Fax:918-426-0443
Practice Address - Street 1:211 N 5TH ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4713
Practice Address - Country:US
Practice Address - Phone:918-426-0106
Practice Address - Fax:918-426-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1154332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200105230BMedicaid
OK410005988OtherMEDICARE ID
OKT40426Medicare UPIN
OK1157110001Medicare NSC
300522317Medicare PIN