Provider Demographics
NPI:1295738011
Name:OKLAHOMA EYE CENTER OPTICAL
Entity type:Organization
Organization Name:OKLAHOMA EYE CENTER OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:M
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-250-4554
Mailing Address - Street 1:9343 S MINGO RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5702
Mailing Address - Country:US
Mailing Address - Phone:918-250-4554
Mailing Address - Fax:918-307-1943
Practice Address - Street 1:9343 S MINGO RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5702
Practice Address - Country:US
Practice Address - Phone:918-250-4554
Practice Address - Fax:918-307-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100744180 BMedicaid
OK100744180 BMedicaid