Provider Demographics
NPI:1740540509
Name:HATFIELD FAMILY EYE CARE, PLLC
Entity type:Organization
Organization Name:HATFIELD FAMILY EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-431-1444
Mailing Address - Street 1:3040 S MUSKOGEE AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5481
Mailing Address - Country:US
Mailing Address - Phone:918-431-1444
Mailing Address - Fax:918-431-1555
Practice Address - Street 1:3040 S MUSKOGEE AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5481
Practice Address - Country:US
Practice Address - Phone:918-431-1444
Practice Address - Fax:918-431-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2305152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKA104304Medicare PIN