Provider Demographics
NPI:1760787923
Name:NORRIS VISION CENTER
Entity Type:Organization
Organization Name:NORRIS VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-640-7670
Mailing Address - Street 1:14800 FORT CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:42262-8304
Mailing Address - Country:US
Mailing Address - Phone:270-640-7670
Mailing Address - Fax:270-640-3651
Practice Address - Street 1:14800 FORT CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:KY
Practice Address - Zip Code:42262-8304
Practice Address - Country:US
Practice Address - Phone:270-640-7670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1761DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1031419496OtherMEDICARE NUMBER
KY7100113250Medicaid
KY1975101OtherMEDICARE PTAN