Provider Demographics
NPI:1912541087
Name:OAK TREE EYE CLINIC 2, INC
Entity Type:Organization
Organization Name:OAK TREE EYE CLINIC 2, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:MAYES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-820-2005
Mailing Address - Street 1:1601 W EVERLY BROS BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-2707
Mailing Address - Country:US
Mailing Address - Phone:270-754-4515
Mailing Address - Fax:270-754-2547
Practice Address - Street 1:952 FAIRVIEW AVE STE 1
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4943
Practice Address - Country:US
Practice Address - Phone:270-781-2220
Practice Address - Fax:270-781-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty