Provider Demographics
NPI:1265637565
Name:WM. DWAYNE SIZEMORE, O.D., PSC
Entity Type:Organization
Organization Name:WM. DWAYNE SIZEMORE, O.D., PSC
Other - Org Name:EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:SIZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-436-2020
Mailing Address - Street 1:161 CITIZENS LN
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1352
Mailing Address - Country:US
Mailing Address - Phone:606-436-3313
Mailing Address - Fax:606-436-2020
Practice Address - Street 1:161 CITIZENS LN
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1352
Practice Address - Country:US
Practice Address - Phone:606-436-3313
Practice Address - Fax:606-436-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY968DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77901627Medicaid
KYT54685Medicare UPIN
KY77901627Medicaid