Healthcare Provider Details

I. General information

NPI: 1568657526
Provider Name (Legal Business Name): JARVIS VISION CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 N. 4TH ST
MURRAY KY
42071
US

IV. Provider business mailing address

1806 N. 4TH ST
MURRAY KY
42071
US

V. Phone/Fax

Practice location:
  • Phone: 270-759-1429
  • Fax: 270-759-1493
Mailing address:
  • Phone: 270-759-1429
  • Fax: 270-759-1493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1707DT
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1707DT
License Number StateKY

VIII. Authorized Official

Name: DR. REED H JARVIS
Title or Position: OWNER
Credential: O.D.
Phone: 270-759-1429