Healthcare Provider Details

I. General information

NPI: 1881051191
Provider Name (Legal Business Name): KENTUCKY FAMILY EYECARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 S LAUREL RD SUITE B
LONDON KY
40744-7862
US

IV. Provider business mailing address

975 S LAUREL RD SUITE B
LONDON KY
40744-7862
US

V. Phone/Fax

Practice location:
  • Phone: 606-878-2020
  • Fax: 606-878-2055
Mailing address:
  • Phone: 606-878-2020
  • Fax: 606-878-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberKY1384DT
License Number StateKY

VIII. Authorized Official

Name: DR. ALISON OVERLEY
Title or Position: OWNER
Credential: OD
Phone: 606-878-2020