Provider Demographics
NPI:1811015910
Name:DAVID M. EADS, O.D. & ASSOCIATES, PSC
Entity Type:Organization
Organization Name:DAVID M. EADS, O.D. & 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:EADS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-679-0033
Mailing Address - Street 1:177 WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-2938
Mailing Address - Country:US
Mailing Address - Phone:606-679-0033
Mailing Address - Fax:
Practice Address - Street 1:177 WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2938
Practice Address - Country:US
Practice Address - Phone:606-679-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1063DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77902203Medicaid
KY0710701Medicare ID - Type Unspecified