1902936347 NPI number — OMNI EYE CENTER EDMOND INC.

Table of content: (NPI 1902936347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902936347 NPI number — OMNI EYE CENTER EDMOND INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OMNI EYE CENTER EDMOND INC.
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:
Provider Other Organization Name Type Code:
6
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:
1902936347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1333 WEST 33RD STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73013-6306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-478-4444
Provider Business Mailing Address Fax Number:
405-478-4497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1333 WEST 33RD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73013-6306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-478-4444
Provider Business Practice Location Address Fax Number:
405-478-4497
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MELTON
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
JEFFREY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
405-478-4444

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2311 , 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)

  • Identifier: 731396793001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 0968340001 . This is a "CIGNA GOVERNMENT SERVICES DMERC" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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