Healthcare Provider Details

I. General information

NPI: 1508036831
Provider Name (Legal Business Name): CALVERT OPTHALMOLOGY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
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
42240-1746
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 NumberMD0000035976
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number36511
License Number StateKY

VIII. Authorized Official

Name: DR. HAROLD M CALVERT I
Title or Position: PRESIDENT
Credential: M.D.
Phone: 270-886-2050