Provider Demographics
NPI:1982678181
Name:MCRAY- DENTON VISION CENTER
Entity Type:Organization
Organization Name:MCRAY- DENTON VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-222-2020
Mailing Address - Street 1:428 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-5865
Mailing Address - Country:US
Mailing Address - Phone:405-222-2020
Mailing Address - Fax:405-222-5555
Practice Address - Street 1:428 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-5865
Practice Address - Country:US
Practice Address - Phone:405-222-2020
Practice Address - Fax:405-222-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0156340001Medicare NSC
OK410016404Medicare PIN
OK410030710Medicare PIN