Provider Demographics
NPI:1770709941
Name:JON E. PAINTER O.D.,P.C
Entity type:Organization
Organization Name:JON E. PAINTER O.D.,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:E
Authorized Official - Last Name:PAINTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-799-7706
Mailing Address - Street 1:619 N. BROADWAY ST.
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160
Mailing Address - Country:US
Mailing Address - Phone:405-799-7706
Mailing Address - Fax:405-799-7715
Practice Address - Street 1:619 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-4813
Practice Address - Country:US
Practice Address - Phone:405-799-7706
Practice Address - Fax:405-799-7715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2048152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0526790001OtherPROVIDER ID
OK100762190AMedicaid
OK0526790001OtherPROVIDER ID
OKOKB5714Medicare PIN
0526790001Medicare NSC