Healthcare Provider Details

I. General information

NPI: 1427244979
Provider Name (Legal Business Name): EYECARE CENTER OPTOMETRIST PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1073 BROADWAY ST
BEATTYVILLE KY
41311-8719
US

IV. Provider business mailing address

1020 GIBSON BAY DR
RICHMOND KY
40475-3448
US

V. Phone/Fax

Practice location:
  • Phone: 606-464-8148
  • Fax: 606-464-0142
Mailing address:
  • Phone: 859-623-3358
  • Fax: 859-623-8141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1069DT
License Number StateKY

VIII. Authorized Official

Name: DR. WILLIAM T REYNOLDS JR.
Title or Position: OWNER
Credential: OD
Phone: 859-623-3358