Provider Demographics
NPI:1043410822
Name:RIVER CITIES EYE CONSULTANT
Entity Type:Organization
Organization Name:RIVER CITIES EYE CONSULTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:S
Authorized Official - Last Name:VALLANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-329-2243
Mailing Address - Street 1:2119 CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101
Mailing Address - Country:US
Mailing Address - Phone:606-329-2243
Mailing Address - Fax:
Practice Address - Street 1:2119 CARTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7733
Practice Address - Country:US
Practice Address - Phone:606-329-2243
Practice Address - Fax:606-324-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41013261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7673570OtherAETNA
KY00331Medicare PIN