Healthcare Provider Details

I. General information

NPI: 1801101258
Provider Name (Legal Business Name): EYECARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6675 ROBERTS RD
ROBARDS KY
42452-9772
US

IV. Provider business mailing address

6675 ROBERTS RD
ROBARDS KY
42452-9772
US

V. Phone/Fax

Practice location:
  • Phone: 270-621-1234
  • Fax: 270-521-1111
Mailing address:
  • Phone: 270-621-1234
  • Fax: 270-521-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUE ELLEN PUJARI
Title or Position: PRESIDENT
Credential:
Phone: 270-621-1234