Provider Demographics
NPI:1851400865
Name:EYE CENTERS OF SOUTHEAST KENTUCKY PSC
Entity Type:Organization
Organization Name:EYE CENTERS OF SOUTHEAST KENTUCKY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:TREVOR
Authorized Official - Last Name:BRISCOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-526-0433
Mailing Address - Street 1:1470 CUMBERLAND FALLS HWY
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701
Mailing Address - Country:US
Mailing Address - Phone:606-526-0433
Mailing Address - Fax:606-526-0434
Practice Address - Street 1:1490 CUMBERLAND FALLS HWY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2721
Practice Address - Country:US
Practice Address - Phone:606-526-0433
Practice Address - Fax:606-526-0434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3725388Medicaid
KY7737Medicare PIN
KY7528Medicare PIN
TN3725388Medicaid
KYDG8223Medicare PIN
KY7526Medicare PIN