Provider Demographics
NPI:1558558361
Name:CENTRAL KENTUCKY OPTOMETRIC ASSOCIATES PSC
Entity Type:Organization
Organization Name:CENTRAL KENTUCKY OPTOMETRIC ASSOCIATES PSC
Other - Org Name:UPTOWN EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/SECRETARY/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:HOLLINGSWORTH-CECCONI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-692-1871
Mailing Address - Street 1:310 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-1428
Mailing Address - Country:US
Mailing Address - Phone:270-692-1871
Mailing Address - Fax:270-692-6785
Practice Address - Street 1:1578 HIGHWAY 44 E UNIT 7
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7172
Practice Address - Country:US
Practice Address - Phone:502-543-0646
Practice Address - Fax:502-543-0648
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL KENTUCKY OPTOMETRIC ASSOCIATES PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1558558361OtherRAILROAD MEDICARE
KY00490001Medicare PIN
KY1278880003Medicare NSC