Provider Demographics
NPI:1467734657
Name:GARBIG FAMILY EYE CARE PSC
Entity Type:Organization
Organization Name:GARBIG FAMILY EYE CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBIG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-441-6540
Mailing Address - Street 1:1400 GLORIA TERRELL DR
Mailing Address - Street 2:
Mailing Address - City:WILDER
Mailing Address - State:KY
Mailing Address - Zip Code:41076-9188
Mailing Address - Country:US
Mailing Address - Phone:859-441-6540
Mailing Address - Fax:859-572-4822
Practice Address - Street 1:1400 GLORIA TERRELL DR
Practice Address - Street 2:SUITE H
Practice Address - City:WILDER
Practice Address - State:KY
Practice Address - Zip Code:41076-9188
Practice Address - Country:US
Practice Address - Phone:859-441-6540
Practice Address - Fax:859-572-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1108DT152W00000X
KYKY1196DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77011088Medicaid
KY77011963Medicaid
KY77011963Medicaid
KY00498001Medicare PIN