Provider Demographics
NPI:1629398128
Name:PETTIGREW EYECARE LLC
Entity Type:Organization
Organization Name:PETTIGREW EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PETTIGREW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-310-3232
Mailing Address - Street 1:111 24TH AVE NW
Mailing Address - Street 2:SUITE 120
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6388
Mailing Address - Country:US
Mailing Address - Phone:405-310-3232
Mailing Address - Fax:
Practice Address - Street 1:111 24TH AVE NW
Practice Address - Street 2:SUITE 120
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6388
Practice Address - Country:US
Practice Address - Phone:405-310-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2176152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty