Provider Demographics
NPI:1124247804
Name:EYE PHYSICIANS OPTICAL LLC
Entity type:Organization
Organization Name:EYE PHYSICIANS OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-732-7159
Mailing Address - Street 1:1455 S DOUGLAS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5269
Mailing Address - Country:US
Mailing Address - Phone:405-732-7159
Mailing Address - Fax:405-741-7018
Practice Address - Street 1:1455 S DOUGLAS BLVD STE C
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5269
Practice Address - Country:US
Practice Address - Phone:405-732-7159
Practice Address - Fax:405-741-7018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherTRICARE FOR LIFE
OK=========001OtherBCBS
OK5417890001Medicare ID - Type Unspecified