Provider Demographics
NPI:1720190101
Name:ASSOCIATES IN EYE CARE, INC.
Entity Type:Organization
Organization Name:ASSOCIATES IN EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:UPCHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-387-5612
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:KY
Mailing Address - Zip Code:42533-0306
Mailing Address - Country:US
Mailing Address - Phone:606-492-2211
Mailing Address - Fax:606-676-0873
Practice Address - Street 1:127 FOOTHILLS AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ALBANY
Practice Address - State:KY
Practice Address - Zip Code:42602-1090
Practice Address - Country:US
Practice Address - Phone:606-387-5612
Practice Address - Fax:606-387-6602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0096603OtherMEDICARE # FOR DR. MARK JACOBS
TN39973; 4209301OtherBCBSTN/BLUECARE/TENNCARE
KY7100184290OtherMEDICAID # FOR DR. BENJAMIN BRENNER
KY77012011OtherMEDICAID # FOR DR. MARK JACOBS
46411OtherOPTUMHEALTH VISION
KY77900520Medicaid
CP0230:013OtherEYEMED
KYK009923OtherMEDICARE PTAN # FOR DR. BRENNER
KY77009298OtherMEDICAID # FOR DR. GARY UPCHURCH
KYCB8623OtherRAILROAD MEDICARE
LA0096602OtherMEDICARE # FOR DR. GARY UPCHURCH
TN1511738Medicaid
KY7100209970Medicaid
LA0096602OtherMEDICARE # FOR DR. GARY UPCHURCH
KY77012011OtherMEDICAID # FOR DR. MARK JACOBS