Legacy Eye Care PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

LEGACY EYE CARE PLLC

Practice address

1207 Cornwell Dr
Yukon, OK 73099-4633

Phone

(405) 354-3384

NPI assigned

Jul 24, 2020

Last updated

Jul 24, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kyle Henderson, ODNPI 1780069609

Title

Optometrist

Phone

(918) 207-6276

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 2

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.

• Kyle Henderson, OD

  • Optometrist
  • Yukon, OK
  • NPI 1780069609
  Medicare reassignment NPD Authorized official
• David Charles Brewer, O.D.

  • Optometrist
  • Yukon, OK
  • NPI 1336277581
  NPD

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

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595548800000",
    "number": "1225647415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10001 ABERDEEN LN",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730997644",
            "telephone_number": "918-207-6276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 CORNWELL DR",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730994633",
            "telephone_number": "405-354-3384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY EYE CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-24",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "918-207-6276",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• LD Riggs PLLC
• Henry Le, M.D.
• Naomi Lee
• Terri Lynne Lee, MA, LPC
• Wanisha Lee
• Heather Dawn Lehman, DNP, APRN, FNP-C
• Sara Lehr, APRN-CNP
• Seth Leissner
• Derek Keith Lemaster
• Michael Scott Lemaster

• Optometrist in Yukon, OK
• Providers in Yukon, OK by specialty
• Optometrist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.