Provider Demographics
NPI:1831350164
Name:PRECISION EYE CARE PROFESSIONALS PLLC
Entity type:Organization
Organization Name:PRECISION EYE CARE PROFESSIONALS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BURLIEN
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-781-3937
Mailing Address - Street 1:760 CAMPBELL LN
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-1085
Mailing Address - Country:US
Mailing Address - Phone:270-781-3937
Mailing Address - Fax:
Practice Address - Street 1:2625 NASHVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4098
Practice Address - Country:US
Practice Address - Phone:270-781-3937
Practice Address - Fax:270-783-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1314DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00800OtherGROUP MEDICARE PTAN