Provider Demographics
NPI:1942625223
Name:ELK CITY EYE CARE PLLC
Entity Type:Organization
Organization Name:ELK CITY EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LEA ANN
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-225-2488
Mailing Address - Street 1:100 ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-2929
Mailing Address - Country:US
Mailing Address - Phone:580-225-2488
Mailing Address - Fax:580-225-2506
Practice Address - Street 1:100 ACCESS RD
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-2929
Practice Address - Country:US
Practice Address - Phone:580-225-2488
Practice Address - Fax:580-225-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2790152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty