Provider Demographics
NPI:1508162975
Name:PRECISION EYECARE PLLC
Entity Type:Organization
Organization Name:PRECISION EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:V
Authorized Official - Last Name:HATHCOAT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-904-9113
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-1109
Mailing Address - Country:US
Mailing Address - Phone:502-904-9113
Mailing Address - Fax:
Practice Address - Street 1:11102 HIGHWAY 44 EAST
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-7211
Practice Address - Country:US
Practice Address - Phone:502-904-9113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1204DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77340339Medicaid
KYT90987Medicare UPIN
KY77340339Medicaid