Provider Demographics
NPI:1053096321
Name:OKLAHOMA EYE INSTITUTE PROCEDURES LLC
Entity type:Organization
Organization Name:OKLAHOMA EYE INSTITUTE PROCEDURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSOUMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-225-1555
Mailing Address - Street 1:1020 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-2831
Mailing Address - Country:US
Mailing Address - Phone:580-225-1555
Mailing Address - Fax:
Practice Address - Street 1:1020 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-2831
Practice Address - Country:US
Practice Address - Phone:580-225-1555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery