Provider Demographics
NPI:1447265269
Name:HEFNER EYE CARE & OPTICAL CENTER, L.L.C.
Entity type:Organization
Organization Name:HEFNER EYE CARE & OPTICAL CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HEFNER POE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-728-8853
Mailing Address - Street 1:5757 NW 132ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-4437
Mailing Address - Country:US
Mailing Address - Phone:405-728-8853
Mailing Address - Fax:405-728-8855
Practice Address - Street 1:5757 NW 132ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-4437
Practice Address - Country:US
Practice Address - Phone:405-728-8853
Practice Address - Fax:405-728-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2039152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK444782132MMedicare ID - Type Unspecified
OKU18692Medicare UPIN
OK1154360001Medicare NSC