Provider Demographics
NPI:1891008009
Name:DOUGLAS B PEARSON INC
Entity Type:Organization
Organization Name:DOUGLAS B PEARSON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-825-6144
Mailing Address - Street 1:11 S ROWE ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-4626
Mailing Address - Country:US
Mailing Address - Phone:918-825-6144
Mailing Address - Fax:918-825-5374
Practice Address - Street 1:11 S ROWE ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4626
Practice Address - Country:US
Practice Address - Phone:918-825-6144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOUGLAS B PEARSON OD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100761440AMedicaid
OKT40603Medicare UPIN
OK3953360001Medicare PIN