Healthcare Provider Details

I. General information

NPI: 1487742078
Provider Name (Legal Business Name): COLE VISION CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 TOWNE MALL
ELIZABETHTOWN KY
42701-6686
US

IV. Provider business mailing address

1704 TOWNE MALL
ELIZABETHTOWN KY
42701-6686
US

V. Phone/Fax

Practice location:
  • Phone: 270-765-3551
  • Fax:
Mailing address:
  • Phone: 270-765-3551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MS. WENDY UHLS
Title or Position: MEDICARE SUPERVISOR
Credential:
Phone: 513-765-3534