Provider Demographics
NPI:1467535849
Name:MCEACHERN, SCOTT K (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:K
Last Name:MCEACHERN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 W WILLOW RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-2511
Mailing Address - Country:US
Mailing Address - Phone:580-237-4772
Mailing Address - Fax:
Practice Address - Street 1:1220 W WILLOW RD
Practice Address - Street 2:SUITE B
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-2511
Practice Address - Country:US
Practice Address - Phone:580-237-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2138152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100765140AMedicaid
OK410032428OtherRAILROAD MEDICARE
OK1175170001OtherPALMETTO-MEDICARE DURABLE
OKU51681Medicare UPIN