Provider Demographics
NPI:1164451019
Name:JOE C. TUCKER, O.D., P.C.S
Entity Type:Organization
Organization Name:JOE C. TUCKER, O.D., P.C.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CLAY
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-843-4082
Mailing Address - Street 1:1220 ASHLEY CIR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3338
Mailing Address - Country:US
Mailing Address - Phone:270-843-4082
Mailing Address - Fax:270-781-4015
Practice Address - Street 1:1220 ASHLEY CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3338
Practice Address - Country:US
Practice Address - Phone:270-843-3904
Practice Address - Fax:270-781-4015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOE C. TUCKER, O.D., P.C.S
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-02
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY940DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00030Medicare PIN