Provider Demographics
NPI:1740453653
Name:EYE CENTER ASSOCIATES SE OKLAHOMA
Entity type:Organization
Organization Name:EYE CENTER ASSOCIATES SE OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:HAYDEN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:903-885-6531
Mailing Address - Street 1:109 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-2138
Mailing Address - Country:US
Mailing Address - Phone:903-885-6531
Mailing Address - Fax:903-885-4916
Practice Address - Street 1:1425 E LINCOLN RD
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-7345
Practice Address - Country:US
Practice Address - Phone:580-286-8288
Practice Address - Fax:903-885-4916
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CENTER ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12247207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty