Healthcare Provider Details

I. General information

NPI: 1386977940
Provider Name (Legal Business Name): WING EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 CROSSROADS BLVD
COLD SPRING KY
41076
US

IV. Provider business mailing address

339 CROSSROADS BLVD
COLD SPRING KY
41076-1379
US

V. Phone/Fax

Practice location:
  • Phone: 859-441-9464
  • Fax: 859-442-2023
Mailing address:
  • Phone: 859-441-9464
  • Fax: 859-442-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5839
License Number StateOH

VIII. Authorized Official

Name: THOMAS F NAGY
Title or Position: OWNER
Credential: O.D.
Phone: 513-921-8433