Provider Demographics
NPI:1871804138
Name:CUSHING VISION CENTER PC
Entity type:Organization
Organization Name:CUSHING VISION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:FIELDING
Authorized Official - Last Name:ZWANZIGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-225-5565
Mailing Address - Street 1:2013 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-2910
Mailing Address - Country:US
Mailing Address - Phone:918-225-5565
Mailing Address - Fax:918-225-5656
Practice Address - Street 1:2013 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-2910
Practice Address - Country:US
Practice Address - Phone:918-225-5565
Practice Address - Fax:918-225-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200332870AMedicaid
OKDS4043Medicare PIN
OK6704040001Medicare NSC
OK200332870AMedicaid