MEDICARE: SCK VISION CARE PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1461DT	KY

General Provider Information

NPI Number	:	1700195443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCK VISION CARE PSC

Provider Business Mailing Address
First Line	:	PO BOX 124
Second Line	:
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-0124
Country	:	US
Telephone Number	:	270-597-2333
Fax Number	:	270-597-2333

Provider Business Practice Location Address
First Line	:	105 MOHAWK ST
Second Line	:
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-8544
Country	:	US
Telephone Number	:	270-597-2333
Fax Number	:	270-597-2333

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JARROD ASHLEY MAYHEW
Credential	:	O.D.
Telephone Number	:	270-597-2333

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	09/29/2010

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Directions to “SCK VISION CARE PSC ” Practice Location

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