Provider Demographics
NPI:1699824912
Name:HELDERMAN & JACOBS VISION CENTER, PLLC
Entity Type:Organization
Organization Name:HELDERMAN & JACOBS VISION CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HELDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:859-498-6001
Mailing Address - Street 1:1 N MAYSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1315
Mailing Address - Country:US
Mailing Address - Phone:859-498-6001
Mailing Address - Fax:859-497-0222
Practice Address - Street 1:1 N MAYSVILLE ST
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1315
Practice Address - Country:US
Practice Address - Phone:859-498-6001
Practice Address - Fax:859-497-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000382769OtherBCBS
KY77000461Medicaid
KY000000382771OtherBCBS
KY77903722Medicaid
KY77007623Medicaid
KY8913Medicare ID - Type UnspecifiedGROUP NUMBER
KYU91236Medicare UPIN
KY77903722Medicaid
KY000000382769OtherBCBS
KY77000461Medicaid