Healthcare Provider Details

I. General information

NPI: 1851384960
Provider Name (Legal Business Name): EYECARE CENTER OPTOMETRIST PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 GIBSON BAY DR
RICHMOND KY
40475-3448
US

IV. Provider business mailing address

1020 GIBSON BAY DR
RICHMOND KY
40475-3448
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-3358
  • Fax: 859-623-8141
Mailing address:
  • Phone: 859-623-3358
  • Fax: 859-623-8141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

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