Provider Demographics
NPI:1295867703
Name:WM DWAYNE SIZEMORE OD PSC
Entity Type:Organization
Organization Name:WM DWAYNE SIZEMORE OD PSC
Other - Org Name:EYE CARE CNTR
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:606-633-5200
Mailing Address - Street 1:29 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-7494
Mailing Address - Country:US
Mailing Address - Phone:606-633-5200
Mailing Address - Fax:606-633-1500
Practice Address - Street 1:29 MAPLE ST
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858-7494
Practice Address - Country:US
Practice Address - Phone:606-633-5200
Practice Address - Fax:606-633-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2008-08-27
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
KY000000048484OtherBCBS
KY1417025OtherUMWA
KY410009550OtherRAILROAD MEDICARE PIN
KY77901627Medicaid
KY0624470001OtherDMERC
KY3155OtherCHA
KYC13977OtherRAILROAD MEDICARE
KY9306501Medicare PIN
KY1417025OtherUMWA
KY3155OtherCHA
KY9179201Medicare PIN
KY000000048484OtherBCBS