Provider Demographics
NPI:1700195443
Name:SCK VISION CARE PSC
Entity Type:Organization
Organization Name:SCK VISION CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:MAYHEW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-597-2333
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42210-0124
Mailing Address - Country:US
Mailing Address - Phone:270-597-2333
Mailing Address - Fax:270-597-2333
Practice Address - Street 1:105 MOHAWK ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42210-8544
Practice Address - Country:US
Practice Address - Phone:270-597-2333
Practice Address - Fax:270-597-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1461DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty