Provider Demographics
NPI:1992054225
Name:EYEQ VISION CENTER PLLC
Entity type:Organization
Organization Name:EYEQ VISION CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-286-2220
Mailing Address - Street 1:7519 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3203
Mailing Address - Country:US
Mailing Address - Phone:405-286-2220
Mailing Address - Fax:405-286-0317
Practice Address - Street 1:7519 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3203
Practice Address - Country:US
Practice Address - Phone:405-286-2220
Practice Address - Fax:405-286-0317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK2286152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKA105639Medicare PIN