Provider Demographics
NPI:1023452463
Name:ALLARD EYE CARE PLLC
Entity type:Organization
Organization Name:ALLARD EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-726-3301
Mailing Address - Street 1:704 N HILL ST
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:OK
Mailing Address - Zip Code:73651-1641
Mailing Address - Country:US
Mailing Address - Phone:580-726-3301
Mailing Address - Fax:580-726-3302
Practice Address - Street 1:704 N HILL ST
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:OK
Practice Address - Zip Code:73651-1641
Practice Address - Country:US
Practice Address - Phone:580-726-3301
Practice Address - Fax:580-726-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2637152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200490370AMedicaid
OK6794580001Medicare NSC
OK298326Medicare PIN