Provider Demographics
NPI:1265565147
Name:TRIAD EYE MEDICAL CLINIC & CATARACT INSTITUTE CO INC
Entity type:Organization
Organization Name:TRIAD EYE MEDICAL CLINIC & CATARACT INSTITUTE CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:L
Authorized Official - Last Name:ABEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-252-2020
Mailing Address - Street 1:6140 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1933
Mailing Address - Country:US
Mailing Address - Phone:918-252-2020
Mailing Address - Fax:918-307-1983
Practice Address - Street 1:3233 E 31ST ST
Practice Address - Street 2:SUTIE #202
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2454
Practice Address - Country:US
Practice Address - Phone:918-743-9494
Practice Address - Fax:918-307-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKCO5028OtherRR MEDICARE
OKCO5028OtherRR MEDICARE
OKTRIADEYEMedicare ID - Type Unspecified