Active NPI
Premier Eyecare of Edmond PLLC
- Optometrist
- Edmond, OK
National Provider Identifier
1295930410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2613
- Legal business name
- PREMIER EYECARE OF EDMOND PLLC
- Practice address
- 2841 NW 173Rd Street
Edmond, OK 73003 - Phone
- (405) 513-8150
- Fax
- (405) 513-8153
- NPI assigned
- Jun 18, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Amber Mayes, O.D.
- Title
- Optometrist
- Phone
- (405) 513-8150
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2613 | OK | Primary |
Addresses
Primary practice location
2841 NW 173Rd Street
Edmond, OK 73003
Mailing address
2841 NW 173Rd St
Edmond, OK 73012-6728
Phone (405) 513-8150
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200115110A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070918000600 | OK | Part B Supplier - Clinic/Group Practice | 2062505944 |
Receives reassigned benefits from 4 practitioners Practice locations: Edmond, OK |
National Provider Directory
National Provider DirectoryLocations
2841 NW 173rd St
Edmond, OK 73012
Phone (405) 513-8150
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Optometrist
- Edmond, OK
- NPI 1396853800
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182124800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1779753600000",
"number": "1295930410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2841 NW 173RD ST",
"city": "EDMOND",
"state": "OK",
"postal_code": "730126728",
"telephone_number": "405-513-8150",
"fax_number": "405-513-8153"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2841 NW 173RD STREET",
"city": "EDMOND",
"state": "OK",
"postal_code": "73003",
"telephone_number": "405-513-8150",
"fax_number": "405-513-8153"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PREMIER EYECARE OF EDMOND PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-06-18",
"last_updated": "2026-05-26",
"certification_date": "2026-05-26",
"status": "A",
"authorized_official_last_name": "MAYES",
"authorized_official_first_name": "AMBER",
"authorized_official_title_or_position": "OPTOMETRIST",
"authorized_official_telephone_number": "405-513-8150",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "OK",
"license": "2613",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200115110A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edmond, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2026; 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.