Healthcare Provider Details

I. General information

NPI: 1245239037
Provider Name (Legal Business Name): PHYSICIANS EYE CENTER OF OWENSBORO, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 FARRELL CRESCENT
OWENSBORO KY
42303
US

IV. Provider business mailing address

2845 FARRELL CRESCENT
OWENSBORO KY
42303
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-3297
  • Fax: 270-926-7325
Mailing address:
  • Phone: 270-926-3297
  • Fax: 270-926-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER D. LATHAM
Title or Position: OFFICE MANAGER
Credential:
Phone: 270-926-3297