Provider Demographics
NPI:1528398047
Name:EYECARE CENTER OPTOMETRIST PSC
Entity Type:Organization
Organization Name:EYECARE CENTER OPTOMETRIST PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-623-3358
Mailing Address - Street 1:205 GERI LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2359
Mailing Address - Country:US
Mailing Address - Phone:859-623-6643
Mailing Address - Fax:859-623-4269
Practice Address - Street 1:205 GERI LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2359
Practice Address - Country:US
Practice Address - Phone:859-623-6643
Practice Address - Fax:859-623-4269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1851384960OtherGROUP NPI