Provider Demographics
NPI:1144204983
Name:KUYKENDALL, ERIC RAY (OD)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:RAY
Last Name:KUYKENDALL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:221 S FLORENCE AVE
Mailing Address - Street 2:150
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-8221
Mailing Address - Country:US
Mailing Address - Phone:918-341-2020
Mailing Address - Fax:918-341-3888
Practice Address - Street 1:221 S FLORENCE AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-8221
Practice Address - Country:US
Practice Address - Phone:918-341-2020
Practice Address - Fax:918-341-3888
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2161152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100761690BMedicaid
OKMK0177044OtherDEA
OK100761690BMedicaid
OKMK0177044OtherDEA