Provider Demographics
NPI:1215064308
Name:EYE CARE FOR TULSA INC.
Entity type:Organization
Organization Name:EYE CARE FOR TULSA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MELLISSA
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-585-1523
Mailing Address - Street 1:3906 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3131
Mailing Address - Country:US
Mailing Address - Phone:918-585-1523
Mailing Address - Fax:918-584-5520
Practice Address - Street 1:3906 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3131
Practice Address - Country:US
Practice Address - Phone:918-585-1523
Practice Address - Fax:918-584-5520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1063152W00000X
OK1020152W00000X
OK2437152W00000X
OK10268207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKCS3822OtherRAIL ROAD MEDICARE
OK100735490AMedicaid
OK=========Medicare ID - Type Unspecified