Provider Demographics
NPI:1508037474
Name:QUALLS & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:QUALLS & ASSOCIATES, INC.
Other - Org Name:YOUR EYE SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:QUALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-775-9900
Mailing Address - Street 1:201 REDBUD DR
Mailing Address - Street 2:
Mailing Address - City:GORE
Mailing Address - State:OK
Mailing Address - Zip Code:74435-5621
Mailing Address - Country:US
Mailing Address - Phone:918-775-9900
Mailing Address - Fax:
Practice Address - Street 1:501 N MAIN ST STE 42
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6329
Practice Address - Country:US
Practice Address - Phone:918-775-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========001OtherBLUE CROSS & BLUE SHIELD