Healthcare Provider Details

I. General information

NPI: 1396737219
Provider Name (Legal Business Name): HAROLD MILTON CALVERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KEETON DR
HOPKINSVILLE KY
42240
US

IV. Provider business mailing address

100 KEETON DR.
HOPKINSVILLE KY
42240
US

V. Phone/Fax

Practice location:
  • Phone: 270-886-2050
  • Fax: 270-886-2007
Mailing address:
  • Phone: 270-886-2050
  • Fax: 270-886-2007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberE-0195
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number04-28667
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD0000035976
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number36511
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: