Provider Demographics
NPI:1437143849
Name:ADVANTAGE EYE CARE, PLLC
Entity Type:Organization
Organization Name:ADVANTAGE EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMER
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-683-2020
Mailing Address - Street 1:411 PARK PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-5449
Mailing Address - Country:US
Mailing Address - Phone:270-683-2020
Mailing Address - Fax:270-686-0000
Practice Address - Street 1:411 PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-5449
Practice Address - Country:US
Practice Address - Phone:270-683-2020
Practice Address - Fax:270-686-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77903623Medicaid
KY45001989OtherEPSDT NUMBER
KY7899Medicare PIN
KY77903623Medicaid