Provider Demographics
NPI:1508036831
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
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:M
Authorized Official - Last Name:CALVERT
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:270-886-2050
Mailing Address - Street 1:100 KEETON DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240
Mailing Address - Country:US
Mailing Address - Phone:270-886-2050
Mailing Address - Fax:270-886-2007
Practice Address - Street 1:100 KEETON DR.
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1746
Practice Address - Country:US
Practice Address - Phone:270-886-2050
Practice Address - Fax:270-886-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36511207W00000X
TNMD0000035976207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN180045298OtherRAILROAD MEDICARE
TN3879306Medicaid
KY64031669Medicaid
KYH17450Medicare UPIN
TN3879306Medicare PIN