Provider Demographics
NPI:1720267461
Name:EYE CARE ON GORE PLLC
Entity type:Organization
Organization Name:EYE CARE ON GORE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-355-3036
Mailing Address - Street 1:1415 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3606
Mailing Address - Country:US
Mailing Address - Phone:580-355-3036
Mailing Address - Fax:580-248-1162
Practice Address - Street 1:1415 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3606
Practice Address - Country:US
Practice Address - Phone:580-355-3036
Practice Address - Fax:580-248-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK805152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100769060AMedicaid
OK=========001OtherBLUE CROSS BLUE SHIELD
OK=========001OtherBLUE CROSS BLUE SHIELD
OK100769060AMedicaid