Provider Demographics
NPI:1275946972
Name:EMMICK EYE CARE, PLLC
Entity Type:Organization
Organization Name:EMMICK EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:EMMICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-927-8700
Mailing Address - Street 1:123 EASTWIND CT
Mailing Address - Street 2:
Mailing Address - City:HAWESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42348-6736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 EASTWIND CT
Practice Address - Street 2:
Practice Address - City:HAWESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42348-6736
Practice Address - Country:US
Practice Address - Phone:270-927-8700
Practice Address - Fax:270-927-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1064DT152W00000X
KY1919DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77010643Medicaid
KYK132971Medicare PIN
KY9355401Medicare PIN