Healthcare Provider Details

I. General information

NPI: 1851543656
Provider Name (Legal Business Name): EYEMART FAMILY VISION CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 08/14/2022
Certification Date: 08/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 TAYLORSVILLE RD STE 106
JEFFERSONTOWN KY
40299-2752
US

IV. Provider business mailing address

9501 TAYLORSVILLE RD STE 106
JEFFERSONTOWN KY
40299-2752
US

V. Phone/Fax

Practice location:
  • Phone: 502-499-2020
  • Fax: 502-499-6747
Mailing address:
  • Phone: 502-499-2020
  • Fax: 502-499-6747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1071DT
License Number StateKY

VIII. Authorized Official

Name: MR. TERRY L GOODMAN
Title or Position: OWNER
Credential: OD
Phone: 502-499-2020