Provider Demographics
NPI:1689734733
Name:DAVID E. KORBER M.D. P.C
Entity Type:Organization
Organization Name:DAVID E. KORBER M.D. P.C
Other - Org Name:EYE CARE ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-947-3330
Mailing Address - Street 1:5320 N PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2098
Mailing Address - Country:US
Mailing Address - Phone:405-947-3330
Mailing Address - Fax:405-947-3494
Practice Address - Street 1:5320 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2098
Practice Address - Country:US
Practice Address - Phone:405-947-3330
Practice Address - Fax:405-947-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20179207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100193860AMedicaid
OK300522133Medicare PIN
OKF81352Medicare UPIN