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NPI Code Detail

MEDICARE: EDMONSON EYE CARE 2016

MEDICARE: EDMONSON EYE CARE 2016
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
1152W00000XOptometrist

General Provider Information

NPI Number : 1851724447
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDMONSON EYE CARE 2016
Provider Business Mailing Address
First Line : 100 PARK PL STE 4
Second Line :
City : BROWNSVILLE
State : KY
Zip : 42210-9036
Country : US
Telephone Number : 270-597-9571
Fax Number : 270-968-0204
Provider Business Practice Location Address
First Line : 100 PARK PL STE 4
Second Line :
City : BROWNSVILLE
State : KY
Zip : 42210-9036
Country : US
Telephone Number : 270-597-9571
Fax Number : 270-968-0204
Authorized Official
Title or Position : OPTOMETRIST
Name : DR. AUBREY SMITH HARLAN
Credential : O.D.
Telephone Number : 270-597-9571
Provider Enumeration Date : 08/19/2013
Last Update Date : 04/05/2016

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Directions to “EDMONSON EYE CARE 2016 ” Practice Location

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