Provider Demographics
NPI:1851479737
Name:NORTHWEST EYE ASSOCIATES PC
Entity Type:Organization
Organization Name:NORTHWEST EYE ASSOCIATES PC
Other - Org Name:JOHN HAWKINS OD INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-256-7755
Mailing Address - Street 1:PO BOX 1128
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73802-1128
Mailing Address - Country:US
Mailing Address - Phone:580-256-7755
Mailing Address - Fax:580-256-4819
Practice Address - Street 1:1709 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-2938
Practice Address - Country:US
Practice Address - Phone:580-256-7755
Practice Address - Fax:580-256-4819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2016-06-23
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
OK100632870CMedicaid
OKCT0824OtherRR MEDICARE GROUP #
OK100632870CMedicaid
OK100522132Medicare PIN