1700966959 NPI number — SENIOR EYE CARE SERVICE OF AMERICA

Table of content: (NPI 1700966959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700966959 NPI number — SENIOR EYE CARE SERVICE OF AMERICA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENIOR EYE CARE SERVICE OF AMERICA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MULTI SERVICE CO.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700966959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 WILLOW BRANCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73072-4506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-360-9778
Provider Business Mailing Address Fax Number:
405-360-8650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3383 N MERIDIAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWCASTLE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73065-3634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-360-2454
Provider Business Practice Location Address Fax Number:
405-360-8650
Provider Enumeration Date:
10/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
CORNELIUS
Authorized Official Middle Name:
JEMEEL
Authorized Official Title or Position:
OPTICIAN/OWNER
Authorized Official Telephone Number:
405-360-2454

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  167076 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)