Provider Demographics
NPI:1205243631
Name:CORNING EYE CENTER, PLLC
Entity type:Organization
Organization Name:CORNING EYE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:NASH
Authorized Official - Last Name:CORNING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-332-1880
Mailing Address - Street 1:1414 ARLINGTON ST
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2646
Mailing Address - Country:US
Mailing Address - Phone:580-332-1880
Mailing Address - Fax:580-332-2214
Practice Address - Street 1:1414 ARLINGTON ST
Practice Address - Street 2:SUITE 1400
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2646
Practice Address - Country:US
Practice Address - Phone:580-332-1880
Practice Address - Fax:580-332-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25023207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty