Healthcare Provider Details

I. General information

NPI: 1528398047
Provider Name (Legal Business Name): EYECARE CENTER OPTOMETRIST PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 GERI LN
RICHMOND KY
40475-2359
US

IV. Provider business mailing address

205 GERI LN
RICHMOND KY
40475-2359
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-6643
  • Fax: 859-623-4269
Mailing address:
  • Phone: 859-623-6643
  • Fax: 859-623-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHEILAH LOWERY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 859-623-3358