Provider Demographics
NPI:1326210451
Name:CALVERT OPTHALMOLOGY PSC
Entity Type:Organization
Organization Name:CALVERT OPTHALMOLOGY PSC
Other - Org Name:CALVERT OPHTHALMOLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:CALVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-886-2050
Mailing Address - Street 1:100 KEETON DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-8756
Mailing Address - Country:US
Mailing Address - Phone:270-886-2050
Mailing Address - Fax:270-886-2007
Practice Address - Street 1:290 CLEAR SKY COURT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-647-4900
Practice Address - Fax:931-647-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000035976207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704121Medicaid
TN4061554OtherBLUECROSS GROUP
TN01035351OtherTN AMERIGROUP
TN180045298OtherRAILROAD MEDICARE
TN180045298OtherRAILROAD MEDICARE
TN3704121Medicaid