Provider Demographics
NPI:1821812645
Name:MOONEY EYECARE CENTRE, PLLC
Entity type:Organization
Organization Name:MOONEY EYECARE CENTRE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:LUTES
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-538-4362
Mailing Address - Street 1:327 EASTBROOKE POINTE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MOUNT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-5577
Mailing Address - Country:US
Mailing Address - Phone:502-538-4362
Mailing Address - Fax:
Practice Address - Street 1:6287 TAYLORSVILLE RD STE 2
Practice Address - Street 2:
Practice Address - City:FISHERVILLE
Practice Address - State:KY
Practice Address - Zip Code:40023-7410
Practice Address - Country:US
Practice Address - Phone:502-538-4362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty