Provider Demographics
NPI:1700988524
Name:GARY R. MORGAN OPTOMETRIST PC
Entity Type:Organization
Organization Name:GARY R. MORGAN OPTOMETRIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMERTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-387-4884
Mailing Address - Street 1:3383 N MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-3634
Mailing Address - Country:US
Mailing Address - Phone:405-387-4884
Mailing Address - Fax:405-387-2772
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:405-387-4884
Practice Address - Fax:405-387-2772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK925152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6356060001Medicare NSC
OK300522259Medicare PIN