Provider Demographics
NPI:1245309095
Name:SCOTT EYE CARE P L L C
Entity type:Organization
Organization Name:SCOTT EYE CARE P L L C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-938-5210
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:SHATTUCK
Mailing Address - State:OK
Mailing Address - Zip Code:73858-0770
Mailing Address - Country:US
Mailing Address - Phone:580-938-5210
Mailing Address - Fax:580-938-2166
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHATTUCK
Practice Address - State:OK
Practice Address - Zip Code:73858
Practice Address - Country:US
Practice Address - Phone:580-938-5210
Practice Address - Fax:580-938-2166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST EYE ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332H00000X
OK2374152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK410049616OtherRAILROAD MEDICARE
OK200078760AMedicaid
OK410049616OtherRAILROAD MEDICARE
OK200078760AMedicaid