Provider Demographics
NPI:1972639722
Name:OWASSO EYE INSTITUTE INC
Entity type:Organization
Organization Name:OWASSO EYE INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-747-3937
Mailing Address - Street 1:12455 E 100TH ST N
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4600
Mailing Address - Country:US
Mailing Address - Phone:918-274-7100
Mailing Address - Fax:918-274-7128
Practice Address - Street 1:12455 E 100TH ST N
Practice Address - Street 2:SUITE 110
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4600
Practice Address - Country:US
Practice Address - Phone:918-274-7100
Practice Address - Fax:918-274-7128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6129620001Medicare NSC