Healthcare Provider Details

I. General information

NPI: 1386825107
Provider Name (Legal Business Name): TERESA PARTIN MORTON OD P S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2647 N US HWY 25
EAST BERNSTADT KY
40729-0548
US

IV. Provider business mailing address

PO BOX 548
EAST BERNSTADT KY
40729-0548
US

V. Phone/Fax

Practice location:
  • Phone: 606-843-6060
  • Fax: 606-843-7243
Mailing address:
  • Phone: 606-843-6060
  • Fax: 606-843-7243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1270DT
License Number StateKY

VIII. Authorized Official

Name: MRS. TERESA PARTIN MORTON
Title or Position: PRESIDENT
Credential: O.D.
Phone: 606-843-6060