Provider Demographics
NPI:1285767848
Name:ADA FAMILY EYE CARE INC
Entity type:Organization
Organization Name:ADA FAMILY EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:GURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-436-2020
Mailing Address - Street 1:309 S TOWNSEND ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-6429
Mailing Address - Country:US
Mailing Address - Phone:580-436-2020
Mailing Address - Fax:
Practice Address - Street 1:309 S TOWNSEND ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-6429
Practice Address - Country:US
Practice Address - Phone:580-436-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK2064152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK410035923OtherMEDICARE RAILROAD
OK100763290BMedicaid
OK410035923OtherMEDICARE RAILROAD
OKU34734Medicare UPIN