Provider Demographics
NPI:1508995895
Name:RIVERPARK EYECARE PLLC
Entity Type:Organization
Organization Name:RIVERPARK EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCHERTZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-685-4966
Mailing Address - Street 1:221 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4139
Mailing Address - Country:US
Mailing Address - Phone:270-685-4966
Mailing Address - Fax:270-686-8058
Practice Address - Street 1:221 ALLEN ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-4139
Practice Address - Country:US
Practice Address - Phone:270-685-4966
Practice Address - Fax:270-686-8058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77900629Medicaid
KY6342Medicare PIN
KY77900629Medicaid