Provider Demographics
NPI:1962821546
Name:GARY R. MORGAN, OPTOMETRIST, P.C.
Entity type:Organization
Organization Name:GARY R. MORGAN, OPTOMETRIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-456-0020
Mailing Address - Street 1:2010 S MUSKOGEE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5439
Mailing Address - Country:US
Mailing Address - Phone:918-456-0020
Mailing Address - Fax:918-456-0030
Practice Address - Street 1:2010 S MUSKOGEE AVE STE B
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5439
Practice Address - Country:US
Practice Address - Phone:918-456-0020
Practice Address - Fax:918-456-0030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARY R. MORGAN, OPTOMETRIST, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK925152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty