Healthcare Provider Details

I. General information

NPI: 1699753673
Provider Name (Legal Business Name): ROSEMARY EMMICK OPTOMETRIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 EASTWIND COURT
HAWESVILLE KY
42348
US

IV. Provider business mailing address

123 EASTWIND COURT
HAWESVILLE KY
42348
US

V. Phone/Fax

Practice location:
  • Phone: 270-927-8700
  • Fax: 270-927-0837
Mailing address:
  • Phone: 270-927-8700
  • Fax: 270-927-0837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1064 DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: