Healthcare Provider Details

I. General information

NPI: 1437143849
Provider Name (Legal Business Name): ADVANTAGE EYE CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 PARK PLAZA DR
OWENSBORO KY
42301-5449
US

IV. Provider business mailing address

411 PARK PLAZA DR
OWENSBORO KY
42301-5449
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-2020
  • Fax: 270-686-0000
Mailing address:
  • Phone: 270-683-2020
  • Fax: 270-686-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. HOMER ANDREW WARD
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 270-683-2020