Provider Demographics
NPI:1649546953
Name:MAYFIELD FAMILY EYECARE, LLC
Entity type:Organization
Organization Name:MAYFIELD FAMILY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-247-5532
Mailing Address - Street 1:333 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2309
Mailing Address - Country:US
Mailing Address - Phone:270-247-5532
Mailing Address - Fax:270-247-0245
Practice Address - Street 1:107 W BROADWAY
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066
Practice Address - Country:US
Practice Address - Phone:270-247-5532
Practice Address - Fax:270-247-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1864DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty