Healthcare Provider Details

I. General information

NPI: 1871008482
Provider Name (Legal Business Name): PROFESSIONALS IN EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 N MCWHORTER ST STE 1
LONDON KY
40741-2235
US

IV. Provider business mailing address

356 N MCWHORTER ST STE 1
LONDON KY
40741-2235
US

V. Phone/Fax

Practice location:
  • Phone: 606-877-6585
  • Fax: 606-877-9936
Mailing address:
  • Phone: 606-877-6585
  • Fax: 606-877-9936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MELISSA BALL
Title or Position: OPTOMETRIST
Credential: OD
Phone: 606-877-6585