Provider Demographics
NPI:1619228814
Name:INSIGHT EYECARE PLLC
Entity Type:Organization
Organization Name:INSIGHT EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:N
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-296-3937
Mailing Address - Street 1:12140 SOUTH WACO AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033
Mailing Address - Country:US
Mailing Address - Phone:918-296-3937
Mailing Address - Fax:832-934-1161
Practice Address - Street 1:12140 SOUTH WACO AVENUE
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033
Practice Address - Country:US
Practice Address - Phone:918-296-3937
Practice Address - Fax:832-934-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2715152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty