Provider Demographics
NPI:1730204165
Name:HERITAGE PARK EYE CARE CENTER
Entity type:Organization
Organization Name:HERITAGE PARK EYE CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-732-2277
Mailing Address - Street 1:2008 S. POST ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130
Mailing Address - Country:US
Mailing Address - Phone:405-732-2277
Mailing Address - Fax:405-737-4776
Practice Address - Street 1:2008 S. POST ROAD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130
Practice Address - Country:US
Practice Address - Phone:405-732-2277
Practice Address - Fax:405-737-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2413332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKCS4518OtherRAILROAD MEDICARE GROUP #
OKCS4518OtherRAILROAD MEDICARE GROUP #
OK0180510001Medicare NSC
OKCS4518OtherRAILROAD MEDICARE GROUP #