Provider Demographics
NPI:1184785867
Name:SOUTHERN OKLAHOMA EYE CENTER LLC
Entity type:Organization
Organization Name:SOUTHERN OKLAHOMA EYE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:580-622-2020
Mailing Address - Street 1:1010 W 3RD ST
Mailing Address - Street 2:PO BOX 499
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-4801
Mailing Address - Country:US
Mailing Address - Phone:580-622-2020
Mailing Address - Fax:580-622-3213
Practice Address - Street 1:1010 W 3RD ST
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4801
Practice Address - Country:US
Practice Address - Phone:580-622-2020
Practice Address - Fax:580-622-3213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0418650001Medicare NSC
OK731511693Medicare PIN
OKCK7425Medicare PIN