Healthcare Provider Details

I. General information

NPI: 1386771178
Provider Name (Legal Business Name): EYECARE NETWORK LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 MEDICAL PARK DR
MAYSVILLE KY
41056-9621
US

IV. Provider business mailing address

1360 MEDICAL PARK DR
MAYSVILLE KY
41056-9621
US

V. Phone/Fax

Practice location:
  • Phone: 606-759-5341
  • Fax: 606-759-7393
Mailing address:
  • Phone: 606-759-5341
  • Fax: 606-759-7393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateKY

VIII. Authorized Official

Name: MRS. SUE PRATER
Title or Position: OFFICE MANAGER
Credential:
Phone: 606-759-5341