Provider Demographics
NPI:1811030075
Name:DRS DUVALL TADE AND ASSOCIATES
Entity Type:Organization
Organization Name:DRS DUVALL TADE AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BURLIEN
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-846-0131
Mailing Address - Street 1:2625 SCOTTSVILLE RD STE 324
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-6379
Mailing Address - Country:US
Mailing Address - Phone:270-846-0131
Mailing Address - Fax:270-846-2231
Practice Address - Street 1:2625 SCOTTSVILLE RD STE 324
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-6379
Practice Address - Country:US
Practice Address - Phone:270-846-0131
Practice Address - Fax:270-846-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1314152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3744Medicare ID - Type Unspecified