Healthcare Provider Details

I. General information

NPI: 1770633018
Provider Name (Legal Business Name): MARY ANNE BELCHER O.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SPRING AVE
ELKHORN CITY KY
41522
US

IV. Provider business mailing address

PO BOX 1237
ELKHORN CITY KY
41522-1237
US

V. Phone/Fax

Practice location:
  • Phone: 606-754-5775
  • Fax: 606-754-5775
Mailing address:
  • Phone: 606-754-5775
  • Fax: 606-754-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1059DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: