Provider Demographics
NPI:1700921798
Name:SENIOR EYE CARE SERVICE OF AMERICA, LLC
Entity Type:Organization
Organization Name:SENIOR EYE CARE SERVICE OF AMERICA, LLC
Other - Org Name:MULTI SERVICE CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORNELIUS
Authorized Official - Middle Name:JEMEEL
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-360-2454
Mailing Address - Street 1:PO BOX 720483
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4354
Mailing Address - Country:US
Mailing Address - Phone:405-360-2454
Mailing Address - Fax:405-360-8650
Practice Address - Street 1:3385 N. MERIDIAN
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065
Practice Address - Country:US
Practice Address - Phone:405-387-4884
Practice Address - Fax:405-360-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK925152W00000X
OK2806152W00000X
OK167076156FX1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic AssistantGroup - Multi-Specialty