Provider Demographics
NPI:1548486095
Name:TULSA EYE CENTER PLLC
Entity type:Organization
Organization Name:TULSA EYE CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:MANEK
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANKLESARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-745-9800
Mailing Address - Street 1:4815 S HARVARD AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3066
Mailing Address - Country:US
Mailing Address - Phone:918-895-7855
Mailing Address - Fax:918-745-9800
Practice Address - Street 1:4815 S HARVARD AVE STE 210
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3066
Practice Address - Country:US
Practice Address - Phone:918-895-7855
Practice Address - Fax:918-745-9800
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TULSA EYE CENTER PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
OK13574156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200032280CMedicaid
OK5395020001Medicare PIN
OK5395020001Medicare NSC
OK200032280CMedicaid