Provider Demographics
NPI:1699817999
Name:PRIMARY EYE CARE ASSOCIATES PSC
Entity Type:Organization
Organization Name:PRIMARY EYE CARE ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-586-3937
Mailing Address - Street 1:1821 FLORENCE PIKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-7941
Mailing Address - Country:US
Mailing Address - Phone:859-586-3937
Mailing Address - Fax:859-689-6232
Practice Address - Street 1:1821 FLORENCE PIKE
Practice Address - Street 2:SUITE 1
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-7941
Practice Address - Country:US
Practice Address - Phone:859-586-3937
Practice Address - Fax:859-689-6232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5233650001Medicare NSC
K068810Medicare PIN