MEDICARE: DR. GARY V HATHCOAT OD

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	18002279	IN
2	152W00000X	Optometrist	1204DT	KY
3	152W00000X	Optometrist	4901004469	MI

General Provider Information

NPI Number	:	1891769345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY V HATHCOAT OD

Provider Business Mailing Address
First Line	:	PO BOX 1109
Second Line	:
City	:	MT WASHINGTON
State	:	KY
Zip	:	40047-1109
Country	:	US
Telephone Number	:	502-904-9933
Fax Number	:	502-904-9935

Provider Business Practice Location Address
First Line	:	11102 HIGHWAY 44 EAST
Second Line	:
City	:	MT WASHINGTON
State	:	KY
Zip	:	40047-7211
Country	:	US
Telephone Number	:	502-904-9933
Fax Number	:	502-904-9935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	04/13/2011

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