NORTHEASTERN STATE UNIVERSITY COLLEGE OF OPTOMETRY (NPI# 1437106333) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437106333 |
| Entity Type | Organization |
| Organization Name | NORTHEASTERN STATE UNIVERSITY COLLEGE OF OPTOMETRY |
| Other Organization Name | NORTHEASTERN STATE UNIVERSITY OKLAHOMA COLLEGE OF OPTOMETRY |
| Practice Address |
1001 N Grand Ave Tahlequah OK 74464-7017 |
| Practice Telephone | 9184582109 |
| Practice Fax Number | 9184582310 |
| Mailing Telephone | 9184582109 |
| Mailing Fax Number | 9184582310 |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2010-08-30 |
| Authorized Official Name | DR. DOUGLAS PENISTEN (DEAN) |
| Authorized Official Telephone | 9184565511 |
| Authorized Official Credential | O.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers | ||
| N | 152WC0802X |
Optometrist Specialization: Corneal and Contact Management |
Eye and Vision Services Providers | ||
| N | 152WL0500X |
Optometrist Specialization: Low Vision Rehabilitation |
Eye and Vision Services Providers | ||
| N | 152WP0200X |
Optometrist Specialization: Pediatrics |
Eye and Vision Services Providers | ||
| N | 152WV0400X |
Optometrist Specialization: Vision Therapy |
Eye and Vision Services Providers | ||
| N | 152WX0102X |
Optometrist Specialization: Occupational Vision |
Eye and Vision Services Providers | ||
| N | 152WS0006X |
Optometrist Specialization: Sports Vision |
Eye and Vision Services Providers | ||
| N | 207W00000X | Ophthalmology | Allopathic & Osteopathic Physicians | ||
| Y | 152W00000X | Optometrist | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100732440A | 05 |
| Other Name | Type Code |
|---|---|
| Northeastern State University Oklahoma College of Optometry | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043327778 | Northeastern State University College of Optometry | Eyewear Supplier (Equipment, not the service) | Route 2 Box 93, Stilwell, OK 74960 | 2006-08-25 |
| 1790899219 | Northeastern State University College of Optometry | Eyewear Supplier (Equipment, not the service) | 1015 Washbourne, Jay, OK 74346 | 2006-08-19 |
| 1134236862 | Northeastern State University College of Optometry | Eyewear Supplier (Equipment, not the service) | 100 S Bliss Ave, Tahlequah, OK 74464-2512 | 2006-08-25 |
| 1972617405 | Northeastern State University College of Optometry | Eyewear Supplier (Equipment, not the service) | 900 N Owen Walters Blvd, Salina, OK 74365-5003 | 2006-08-19 |
| 1629182167 | Northeastern State University College of Optometry | Eyewear Supplier (Equipment, not the service) | 301 J T Stites Blvd, Sallisaw, OK 74955-9302 | 2006-08-19 |
| Street Address |
1001 N GRAND AVE |
| City | TAHLEQUAH |
| State | OK |
| Zip Code | 74464-7017 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891786778 | Leland Carr | Optometrist | 1001 N Grand Ave, Tahlequah, OK 74464-7017 | 2005-10-31 |
| 1588285613 | Jennifer Dryden | Optometrist | 1001 N Grand Ave, Tahlequah, OK 74464-7017 | 2020-04-29 |
| 1811518004 | Colleen Annalina Tejchma | Optometrist | 1001 N Grand Ave, Tahlequah, OK 74464-7017 | 2020-04-29 |
| 1073132395 | Kristen Lantz | Optometrist | 1001 N Grand Ave, Tahlequah, OK 74464-7017 | 2020-04-16 |
| 1417577719 | Neil Hecker | Optometrist | 1001 N Grand Ave, Tahlequah, OK 74464-7017 | 2020-04-16 |
| 1063065522 | Laura Lai Ming Chan | Optometrist | 1001 N Grand Ave, Tahlequah, OK 74464-7017 | 2019-07-23 |
| 1629621263 | Dana Denise Rhea | Optometrist | 1001 N Grand Ave, Tahlequah, OK 74464-7017 | 2019-07-23 |
| 1104478296 | Jennifer Rider | Optometrist | 1001 N Grand Ave, Tahlequah, OK 74464-7017 | 2019-07-10 |
| 1932660974 | Nha Cao | Optometrist | 1001 N Grand Ave, Tahlequah, OK 74464 | 2019-03-30 |
| 1235616897 | Sergiu Daniel Picioreanu | Optometrist | 1001 N Grand Ave, Tahlequah, OK 74464-7017 | 2018-07-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184253403 | Kendall Harris | Student in an Organized Health Care Education/Training Program | 100 Bliss Ave, Tahlequah, OK 74464 | 2020-04-07 |
| 1528609302 | Norma Brightly | Technician | 103 Sequoyah, Tahlequah, OK 74464 | 2019-10-03 |
| 1073175832 | Jody Lynn Dallis | Case Manager/Care Coordinator | Tenkiller Behavioral Services, 27753 S. Welling Rd, Welling, OK 74464 | 2019-07-02 |
| 1184287849 | Perry Jake Proctor | Student in an Organized Health Care Education/Training Program | 1400 E Downing St, Tahlequah, Ok 74464, Tahlequah, OK 74464 | 2019-04-18 |
| 1336657279 | Sidney Sheyenne Kimble | Case Manager/Care Coordinator | 1429 Jack Brown Lane, Tahlequah, OK 74464 | 2018-01-12 |
| 1891225686 | Nichols Bradley Alberty | Orthotist | 1294 East Downing, Suite 3, Tahlequah, OK 74464 | 2017-06-14 |
| 1922549690 | Krystal Easter Ms, Lpc | Counselor | 2201 Oakridge Dr, Tahlequah, OK 74464 | 2017-03-15 |
| 1144777319 | Northeastern Oklahoma Community Health Centers, Inc. | Clinic/Center | 529 N. Oak St., Tahlequah, OK 74464 | 2016-09-06 |
| 1548713456 | Clement Isioma Nwadozi | Optometrist | 3763 Southridge Cir Apt 6, Tahlequah, OK 74464 | 2016-07-27 |
| 1033532635 | Wesley Gragg | Specialist/Technologist | 603 North Grand Avenue, Tahlequah, OK 74464 | 2014-02-03 |
| Find all providers in zip 74464 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770190779 | Nate Richard Castillo | Optometrist | 2625 Cambridge Cir, Tahlequah, OK 74464-4690 | 2020-09-24 |
| 1396365581 | Ryan Swindell | Optometrist | 1504 Northpark Dr, Tahlequah, OK 74464-6241 | 2020-04-17 |
| 1285289694 | Bret Wilmon | Optometrist | 1402 N Vinita Ave Unit 5, Tahlequah, OK 74464-6483 | 2019-08-03 |
| 1548713456 | Clement Isioma Nwadozi | Optometrist | 3763 Southridge Cir Apt 6, Tahlequah, OK 74464 | 2016-07-27 |
| 1750766325 | Wyatt Williams | Optometrist | 17900 S Muskogee Ave, Tahlequah, OK 74464-5494 | 2015-07-24 |
| 1790160455 | Samantha Giang | Optometrist | 3857 Southridge Cir, Apt #2, Tahlequah, OK 74464-7948 | 2015-07-23 |
| 1962821546 | Gary R. Morgan, Optometrist, P.C. | Optometrist | 2010 S Muskogee Ave Ste B, Tahlequah, OK 74464-5439 | 2014-04-10 |
| 1740540509 | Hatfield Family Eye Care, Pllc | Optometrist | 3040 S Muskogee Ave, Suite 109, Tahlequah, OK 74464-5481 | 2012-05-25 |
| 1225301443 | Michael William Gaydos | Optometrist | 14140 N Mandy Rd, Tahlequah, OK 74464-0658 | 2012-02-18 |
| 1790099786 | Tory L Dotson | Optometrist | 105 Mimosa Ln, Tahlequah, OK 74464-5703 | 2010-08-02 |
| Find all providers in TAHLEQUAH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.