Provider Demographics
NPI:1871639005
Name:SEGREE, JOSEPH WILLIAM (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:SEGREE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718
Mailing Address - Country:US
Mailing Address - Phone:270-569-9145
Mailing Address - Fax:
Practice Address - Street 1:725 CAMPBELLSVILLE BYPASS
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718
Practice Address - Country:US
Practice Address - Phone:270-465-7669
Practice Address - Fax:270-789-0643
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY86905152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77008696Medicare ID - Type Unspecified
9317701Medicare ID - Type Unspecified
T54538Medicare UPIN