Provider Demographics
NPI:1689611949
Name:WWR, PSC
Entity Type:Organization
Organization Name:WWR, PSC
Other - Org Name:GEORGETOWN EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:859-321-1029
Mailing Address - Street 1:1299 STANDISH WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2045
Mailing Address - Country:US
Mailing Address - Phone:859-523-3553
Mailing Address - Fax:
Practice Address - Street 1:103 S BRADFORD LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-2336
Practice Address - Country:US
Practice Address - Phone:859-321-1029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1845DT152W00000X
KY38932207W00000X
KY45851207W00000X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty