Provider Demographics
NPI:1851543656
Name:EYEMART FAMILY VISION CARE INC
Entity Type:Organization
Organization Name:EYEMART FAMILY VISION CARE INC
Other - Org Name:EYE MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-499-2020
Mailing Address - Street 1:9501 TAYLORSVILLE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2752
Mailing Address - Country:US
Mailing Address - Phone:502-499-2020
Mailing Address - Fax:502-499-6747
Practice Address - Street 1:9501 TAYLORSVILLE RD STE 106
Practice Address - Street 2:
Practice Address - City:JEFFERSONTOWN
Practice Address - State:KY
Practice Address - Zip Code:40299-2752
Practice Address - Country:US
Practice Address - Phone:502-499-2020
Practice Address - Fax:502-499-6747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-13
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1071DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77010718Medicaid
KY77901775Medicaid
KY0822860001Medicare NSC