Eyecare of Grand Lake PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

EYECARE OF GRAND LAKE PLLC

Practice address

720 S Main St
Grove, OK 74344-2841

Phone

(918) 791-6600

NPI assigned

May 20, 2021

Last updated

Jul 21, 2022By 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

Jordan Barnwell, ODNPI 1205389566

Title

Ceo

Phone

(918) 791-6600

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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.

• Jordan Barnwell, OD

  • Optometrist
  • Tulsa, OK
  • NPI 1205389566
  Medicare reassignment Care Compare group NPD Authorized official
• Burness R Yandell, OD

  • Optometrist
  • Grove, OK
  • NPI 1962442848
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1932774189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 S MAIN ST",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "74344",
            "telephone_number": "918-791-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 S MAIN ST",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "743442841",
            "telephone_number": "918-791-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE OF GRAND LAKE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-20",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-11",
        "status": "A",
        "authorized_official_last_name": "BARNWELL",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-791-6600",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200656200A",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "RevolutionEHR",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "address_1": "720 S. Main Street",
            "city": "Grove",
            "state": "OK",
            "country_code": "US",
            "postal_code": "74344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elite Physical Therapy and Wellness
• Shawna S Ellick, BS
• Toni Lucas Elliott, LCSW
• Margaret P Ellis, MD
• Merrick Ellis, RBT
• Melissa Lynne Falley, BACHELOR OF SCIENCE
• Family Care Spec, Inc., P.C.
• Joseph Michael Ferguson, D.C.
• Sammie Jo Ferguson, D.C.
• Dawn Rechele Fields

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.