Provider Demographics
NPI:1295162550
Name:HARRAH EYE CLINIC PLLC
Entity type:Organization
Organization Name:HARRAH EYE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ACORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-454-0099
Mailing Address - Street 1:1087 N HARRAH RD
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045
Mailing Address - Country:US
Mailing Address - Phone:405-454-0099
Mailing Address - Fax:405-454-0432
Practice Address - Street 1:1087 N HARRAH RD
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045
Practice Address - Country:US
Practice Address - Phone:405-454-0099
Practice Address - Fax:405-454-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKA102567Medicare PIN