Organization
EYECARE OF GRAND LAKE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN BARNWELL OD (CEO)
(918) 791-6600
Entity
Organization
Contact information
Practice address
720 S MAIN ST, GROVE, OK 74344-2841
(918) 791-6600
Mailing address
720 S MAIN ST, GROVE, OK 74344
(918) 791-6600
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200656200A
—
OK
Enumeration date
05/20/2021
Last updated
07/21/2022
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