Provider Demographics
NPI:1447671664
Name:BA EYE SITE, PLLC
Entity type:Organization
Organization Name:BA EYE SITE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:OZMENT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-248-6306
Mailing Address - Street 1:2500 W NEW ORLEANS ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1574
Mailing Address - Country:US
Mailing Address - Phone:405-213-3837
Mailing Address - Fax:
Practice Address - Street 1:2500 W NEW ORLEANS ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-1574
Practice Address - Country:US
Practice Address - Phone:405-213-3837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2368152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty