Provider Demographics
NPI:1710103395
Name:DEAN MCGEE EYE INSTITUTE
Entity Type:Organization
Organization Name:DEAN MCGEE EYE INSTITUTE
Other - Org Name:DEAN MCGEE OPTICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:GEIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-271-5214
Mailing Address - Street 1:3201 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6378
Mailing Address - Country:US
Mailing Address - Phone:580-250-5855
Mailing Address - Fax:580-250-5808
Practice Address - Street 1:3201 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6378
Practice Address - Country:US
Practice Address - Phone:580-250-5855
Practice Address - Fax:580-250-5808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEAN MCGEE EYE INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-18
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100749530CMedicaid