Provider Demographics
NPI:1932458528
Name:BRETT ENYART, OD, PLLC
Entity Type:Organization
Organization Name:BRETT ENYART, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:M
Authorized Official - Last Name:ENYART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-640-8010
Mailing Address - Street 1:5335 W ROGERS BLVD
Mailing Address - Street 2:STE. B
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-5284
Mailing Address - Country:US
Mailing Address - Phone:918-396-4440
Mailing Address - Fax:918-396-4449
Practice Address - Street 1:5335 W ROGERS BLVD
Practice Address - Street 2:STE. B
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-5284
Practice Address - Country:US
Practice Address - Phone:918-396-4440
Practice Address - Fax:918-396-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKCO5028OtherMEDICARE ID
OKCO5028OtherMEDICARE ID
OKU81733Medicare UPIN