Provider Demographics
NPI:1265726301
Name:MASSENGALE EYE CARE, PLLC
Entity type:Organization
Organization Name:MASSENGALE EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CURT
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:MASSENGALE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-631-2020
Mailing Address - Street 1:2828 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-4304
Mailing Address - Country:US
Mailing Address - Phone:405-631-2020
Mailing Address - Fax:405-631-2114
Practice Address - Street 1:2828 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-4304
Practice Address - Country:US
Practice Address - Phone:405-631-2020
Practice Address - Fax:405-631-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100761620AMedicaid
OKT40553Medicare UPIN
OK6685590001Medicare NSC