Provider Demographics
NPI:1700966959
Name:SENIOR EYE CARE SERVICE OF AMERICA
Entity Type:Organization
Organization Name:SENIOR EYE CARE SERVICE OF AMERICA
Other - Org Name:MULTI SERVICE CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN/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:ABOC
Authorized Official - Phone:405-360-2454
Mailing Address - Street 1:117 WILLOW BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4506
Mailing Address - Country:US
Mailing Address - Phone:405-360-9778
Mailing Address - Fax:405-360-8650
Practice Address - Street 1:3383 N MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-3634
Practice Address - Country:US
Practice Address - Phone:405-360-2454
Practice Address - Fax:405-360-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK167076313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility