NPIMap

Organization Active NPI

Eye Care Specialists of Oklahoma PLLC

  • Ophthalmology Physician
  • Edmond, OK
National Provider Identifier
1427556166
Registry record updated Apr 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
29168 Issued in OK
Legal business name
EYE CARE SPECIALISTS OF OKLAHOMA PLLC
Practice address
3431 S Boulevard Ste 105
Edmond, OK 73013
Phone
(405) 562-2036
Fax
(405) 562-2116
NPI assigned
Jan 29, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2020

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

Authorized official

Name
Jared R Jackson, MDNPI 1730476730
Title
Provider
Phone
(405) 771-0880

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 29168 OK Primary
Medical Specialty Clinic/Center 261QM2500X
Ophthalmologic Surgery Clinic/Center 261QS0132X

Addresses

Primary practice location

3431 S Boulevard Ste 105
Edmond, OK 73013

Mailing address

PO Box 1803
Edmond, OK 73083-1803
Phone (405) 418-4800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jjackson@jackson.integrityemrdirectemr.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180227000058 OK Part B Supplier - Clinic/Group Practice 4789945239 Receives reassigned benefits from 5 practitioners
Practice locations: Edmond, OK; Yukon, OK; Mustang, OK; Moore, OK; Midwest City, OK; Lawton, OK; Altus, OK

National Provider Directory

National Provider Directory

Locations

3431 S Boulevard
Ste 105
Edmond, OK 73013
Phone (405) 341-6941

2150 S Douglas Blvd
Ste H
Oklahoma City, OK 73130
Phone (405) 771-0880

12444 NW 10th St
Yukon, OK 73099
Phone (405) 999-0297

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1517184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587427200000",
    "number": "1427556166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1803",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730831803",
            "telephone_number": "405-418-4800",
            "fax_number": "405-418-4820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3431 S BOULEVARD STE 105",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "73013",
            "telephone_number": "405-562-2036",
            "fax_number": "405-562-2116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CARE SPECIALISTS OF OKLAHOMA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-29",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JARED",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "405-771-0880",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "OK",
            "license": "29168",
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS0132X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ophthalmologic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jjackson@jackson.integrityemrdirectemr.com",
            "affiliation": "N",
            "endpointDescription": "provider",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3431 S Boulevard Ste 105",
            "city": "Edmond",
            "state": "OK",
            "country_code": "US",
            "postal_code": "73013",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Apr 21, 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.