Healthcare Provider Details

I. General information

NPI: 1669384020
Provider Name (Legal Business Name): EAST KENTUCKY EYECARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4169 N MAYO TRL
PIKEVILLE KY
41501-3211
US

IV. Provider business mailing address

4169 N MAYO TRL
PIKEVILLE KY
41501-3211
US

V. Phone/Fax

Practice location:
  • Phone: 606-432-5800
  • Fax: 606-437-2307
Mailing address:
  • Phone: 606-432-5800
  • Fax: 606-437-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ZACHARY THOMAS WALTERS
Title or Position: OWNER/MEMBER
Credential: OD
Phone: 606-432-5800