Provider Demographics
NPI:1821219916
Name:EASTLAND OPTICAL INC
Entity Type:Organization
Organization Name:EASTLAND OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-437-0677
Mailing Address - Street 1:10651 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-1602
Mailing Address - Country:US
Mailing Address - Phone:918-437-0677
Mailing Address - Fax:918-437-6362
Practice Address - Street 1:10651 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-1602
Practice Address - Country:US
Practice Address - Phone:918-437-0677
Practice Address - Fax:918-437-6362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier