Provider Demographics
NPI:1780794321
Name:HENRY MATT MAGEE OD, PSC
Entity type:Organization
Organization Name:HENRY MATT MAGEE OD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:MATT
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-878-7500
Mailing Address - Street 1:930 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-2521
Mailing Address - Country:US
Mailing Address - Phone:606-878-7500
Mailing Address - Fax:
Practice Address - Street 1:930 E 4TH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2521
Practice Address - Country:US
Practice Address - Phone:606-878-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0444900001Medicare NSC