Provider Demographics
NPI:1477732782
Name:MAYER EYE CARE, INC
Entity Type:Organization
Organization Name:MAYER EYE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-762-0870
Mailing Address - Street 1:1722 N 4TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2745
Mailing Address - Country:US
Mailing Address - Phone:580-762-0870
Mailing Address - Fax:580-762-0871
Practice Address - Street 1:1722 N 4TH ST STE C
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2745
Practice Address - Country:US
Practice Address - Phone:580-762-0870
Practice Address - Fax:580-762-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2343152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200074960AMedicaid
900522345Medicare PIN
OK5478300001Medicare NSC