Healthcare Provider Details

I. General information

NPI: 1932227097
Provider Name (Legal Business Name): PIKEVILLE OPTICAL COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3469 N MAYO TRL
PIKEVILLE KY
41501-3265
US

IV. Provider business mailing address

3469 N MAYO TRL
PIKEVILLE KY
41501-3265
US

V. Phone/Fax

Practice location:
  • Phone: 606-437-7702
  • Fax:
Mailing address:
  • Phone: 606-437-7702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number509
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number509 OPTICIAN
License Number StateKY

VIII. Authorized Official

Name: JAMES SMALLWOOD
Title or Position: PRESIDENT
Credential: OPTICIAN
Phone: 606-437-7702