Provider Demographics
NPI:1750475760
Name:EYECARE ASSOCIATES OF SOUTH TULSA PC
Entity Type:Organization
Organization Name:EYECARE ASSOCIATES OF SOUTH TULSA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-250-2020
Mailing Address - Street 1:10010 E 81ST ST
Mailing Address - Street 2:#100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5726
Mailing Address - Country:US
Mailing Address - Phone:918-250-2020
Mailing Address - Fax:918-250-8910
Practice Address - Street 1:10010 E 81ST ST
Practice Address - Street 2:#100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5726
Practice Address - Country:US
Practice Address - Phone:918-250-2020
Practice Address - Fax:918-250-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2147152W00000X
OK4088207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200094000AMedicaid
OK6708040001OtherDMEMACS
OK500522178OtherMEDICARE
OKDF5413OtherRAILROAD MEDICARE