Texarkana Eye Associates-Broken Bow Branch

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

TEXARKANA EYE ASSOCIATES-BROKEN BOW BRANCH

Practice address

511 S Park Dr
Suite a
Broken Bow, OK 74728-5329

Phone

(580) 584-3434

NPI assigned

Jan 18, 2016

Last updated

Oct 3, 2016By 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

Elvin W Fenton, OD

Title

Owner

Phone

(903) 838-0783

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1453075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475452800000",
    "number": "1467819730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2703 RICHMOND RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032328",
            "telephone_number": "903-838-0783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 S PARK DR",
            "address_2": "SUITE A",
            "city": "BROKEN BOW",
            "state": "OK",
            "postal_code": "747285329",
            "telephone_number": "580-584-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXARKANA EYE ASSOCIATES-BROKEN BOW BRANCH",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-18",
        "last_updated": "2016-10-03",
        "status": "A",
        "authorized_official_last_name": "FENTON",
        "authorized_official_first_name": "ELVIN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-838-0783",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Broken Bow, OK
• Providers in Broken Bow, OK by specialty
• Optometrist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2016; 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.