Provider Demographics
NPI:1851724447
Name:EDMONSON EYE CARE 2016
Entity Type:Organization
Organization Name:EDMONSON EYE CARE 2016
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:HARLAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-597-9571
Mailing Address - Street 1:100 PARK PL STE 4
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42210-9036
Mailing Address - Country:US
Mailing Address - Phone:270-597-9571
Mailing Address - Fax:270-968-0204
Practice Address - Street 1:100 PARK PL STE 4
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42210-9036
Practice Address - Country:US
Practice Address - Phone:270-597-9571
Practice Address - Fax:270-968-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty