Provider Demographics
NPI:1447424676
Name:FIRST LOOK EYEWEAR LLC
Entity Type:Organization
Organization Name:FIRST LOOK EYEWEAR LLC
Other - Org Name:FIRST LOOK EYEWEAR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEEMASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-799-7510
Mailing Address - Street 1:2909 S TELEPHONE ROAD
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2937
Mailing Address - Country:US
Mailing Address - Phone:405-793-1181
Mailing Address - Fax:405-790-0891
Practice Address - Street 1:2909 S TELEPHONE ROAD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2937
Practice Address - Country:US
Practice Address - Phone:405-793-1181
Practice Address - Fax:405-790-0891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6206180001Medicare NSC