Provider Demographics
NPI:1215401146
Name:INSIGHT EYECARE JENKS PLLC
Entity type:Organization
Organization Name:INSIGHT EYECARE JENKS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-296-3937
Mailing Address - Street 1:12140 S WACO AVE
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-5660
Mailing Address - Country:US
Mailing Address - Phone:918-296-3937
Mailing Address - Fax:918-296-3938
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3746
Practice Address - Country:US
Practice Address - Phone:918-296-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty