Provider Demographics
NPI:1740459858
Name:SCOTT K. MCEACHERN, O.D.
Entity type:Organization
Organization Name:SCOTT K. MCEACHERN, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCEACHERN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-237-4772
Mailing Address - Street 1:1220 W WILLOW RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-2511
Mailing Address - Country:US
Mailing Address - Phone:580-237-4772
Mailing Address - Fax:580-237-4841
Practice Address - Street 1:1220 W WILLOW RD
Practice Address - Street 2:SUITE B
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-2511
Practice Address - Country:US
Practice Address - Phone:580-237-4772
Practice Address - Fax:580-237-4841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2138332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1467535849OtherINDIVIDUAL NPI
OK446729405001OtherBLUE CROSS BLUE SHIELD
OKU51681Medicare UPIN
OK1175170001Medicare NSC