Organization
GROVE EYE CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BURNESS R YANDELL OD (PRESIDENT)
(918) 786-9777
Entity
Organization
Contact information
Practice address
1013 S MAIN ST, GROVE, OK 74344-2847
(918) 786-9777
(918) 786-8458
Mailing address
PO BOX 452529, GROVE, OK 74345-2529
(918) 786-9777
(918) 786-8458
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2608
OK
152W00000X
Optometrist
Primary
970
OK
152WC0802X
Corneal and Contact Management Optometrist
2608
OK
152WC0802X
Corneal and Contact Management Optometrist
970
OK
152WL0500X
Low Vision Rehabilitation Optometrist
2608
OK
152WL0500X
Low Vision Rehabilitation Optometrist
970
OK
152WP0200X
Pediatric Optometrist
2608
OK
152WP0200X
Pediatric Optometrist
970
OK
152WS0006X
Sports Vision Optometrist
2608
OK
152WS0006X
Sports Vision Optometrist
970
OK
152WV0400X
Vision Therapy Optometrist
2608
OK
152WV0400X
Vision Therapy Optometrist
970
OK
152WX0102X
Occupational Vision Optometrist
2608
OK
152WX0102X
Occupational Vision Optometrist
970
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100763110A
—
OK
01
—
1407038417
ADVANTRA FREEDOM
OK
01
—
731086218001
BLUE CROSS BLUE SHIELD
—
Enumeration date
11/30/2007
Last updated
03/17/2011
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