Provider Demographics
NPI:1386800019
Name:NORTHEAST OKLAHOMA EYE INSTITUTE
Entity type:Organization
Organization Name:NORTHEAST OKLAHOMA EYE INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-392-2780
Mailing Address - Street 1:2408 E 81ST ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4200
Mailing Address - Country:US
Mailing Address - Phone:918-392-2780
Mailing Address - Fax:
Practice Address - Street 1:2408 E 81ST ST
Practice Address - Street 2:SUITE 600
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4200
Practice Address - Country:US
Practice Address - Phone:918-392-2789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty