NPIMap

Organization Active NPI

Grand Lake Eye Care, PC

  • Specialist
  • Grove, OK
National Provider Identifier
1073649844
Registry record updated Nov 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
21196 Issued in OK
Legal business name
GRAND LAKE EYE CARE, PC
Practice address
1120 Neo Loop
Grove, OK 74344
Phone
(918) 787-2020
Fax
(918) 787-6002
NPI assigned
Feb 26, 2007
Last updated
Nov 18, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kevin K Toller, MDNPI 1457373466
Title
President
Phone
(918) 787-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 21196 OK Primary

Addresses

Primary practice location

1120 Neo Loop
Grove, OK 74344

Mailing address

PO Box 450400
Grove, OK 74345
Phone (918) 787-2020

Other identifiers 3

IdentifierTypeStateIssuer
100138230AMedicaidOK
180037253OtherOKRAILROAD MEDICARE
200216660AMedicaidOK

National Provider Directory

National Provider Directory

Locations

601 E 13th St
Ste A
Grove, OK 74344
Phone (918) 786-4914

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290038400000",
    "number": "1073649844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 450400",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "74345",
            "telephone_number": "918-787-2020",
            "fax_number": "918-787-6002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 NEO LOOP",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "74344",
            "telephone_number": "918-787-2020",
            "fax_number": "918-787-6002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND LAKE EYE CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2010-11-18",
        "status": "A",
        "authorized_official_last_name": "TOLLER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-787-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "OK",
            "license": "21196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100138230A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "180037253",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200216660A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grove, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.