Provider Demographics
NPI:1346436888
Name:EYECARE CENTER OPTOMETRIST PSC
Entity Type:Organization
Organization Name:EYECARE CENTER OPTOMETRIST PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:859-623-3358
Mailing Address - Street 1:1020 GIBSON BAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3448
Mailing Address - Country:US
Mailing Address - Phone:859-623-3358
Mailing Address - Fax:859-623-8141
Practice Address - Street 1:114 E REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-1248
Practice Address - Country:US
Practice Address - Phone:859-272-2449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1545DT152W00000X
KY1644DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1157440006Medicare NSC
9581Medicare PIN