Provider Demographics
NPI:1508901836
Name:ENID EYE INC.
Entity Type:Organization
Organization Name:ENID EYE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-233-4711
Mailing Address - Street 1:615 E OKLAHOMA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5951
Mailing Address - Country:US
Mailing Address - Phone:580-233-4711
Mailing Address - Fax:580-234-6686
Practice Address - Street 1:615 E OKLAHOMA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5951
Practice Address - Country:US
Practice Address - Phone:580-233-4711
Practice Address - Fax:580-234-6686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK442347685001OtherBLUE CROSS BLUE SHIELD
OKCJ2331OtherRAILROAD MEDICARE
OK100729900AMedicaid
OK0748750001OtherCIGNA DMERC
OK100729900AMedicaid