Provider Demographics
NPI:1790823300
Name:EYE RESTORATION CLINIC
Entity Type:Organization
Organization Name:EYE RESTORATION CLINIC
Other - Org Name:ELSIE M. JOY, B.C.O.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OCULARIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOY
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:918-664-6544
Mailing Address - Street 1:4606 S GARNETT RD
Mailing Address - Street 2:#302
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5231
Mailing Address - Country:US
Mailing Address - Phone:918-664-6544
Mailing Address - Fax:918-664-0668
Practice Address - Street 1:4606 S GARNETT RD
Practice Address - Street 2:#302
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5231
Practice Address - Country:US
Practice Address - Phone:918-664-6544
Practice Address - Fax:918-664-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNON REQUIRED335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK546768030001OtherBLUE LINCS HMO
OK546768030001OtherBCBS
OK0259450001OtherRR MEDICARE
OK=========00001OtherDEPT OF REHAB
OK=========OtherTRICARE
OK546768030001OtherBCBS