Provider Demographics
NPI:1811044951
Name:EADS, DAVID M (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:EADS
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 1:177 WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-2938
Mailing Address - Country:US
Mailing Address - Phone:606-679-0033
Mailing Address - Fax:606-679-0152
Practice Address - Street 1:177 WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2938
Practice Address - Country:US
Practice Address - Phone:606-679-0033
Practice Address - Fax:606-679-0152
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1063DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77902203Medicaid
KY77010635Medicaid
KY77010635Medicaid