Provider Demographics
NPI:1699920397
Name:CLAREMORE PRYOR EYE CLINIC P A
Entity type:Organization
Organization Name:CLAREMORE PRYOR EYE CLINIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:REINECKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-342-4222
Mailing Address - Street 1:1020 NE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-4014
Mailing Address - Country:US
Mailing Address - Phone:918-825-4427
Mailing Address - Fax:
Practice Address - Street 1:1020 NE 1ST ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4014
Practice Address - Country:US
Practice Address - Phone:918-825-4427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK152W00000X, 207W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4182310001Medicare NSC
OK4182310002Medicare NSC