Healthcare Provider Details

I. General information

NPI: 1578502258
Provider Name (Legal Business Name): EYE HEALTH SPECIALISTS II, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 E MAIN ST
STANFORD KY
40484-1404
US

IV. Provider business mailing address

713 E MAIN ST.
STANFORD KY
40484
US

V. Phone/Fax

Practice location:
  • Phone: 606-365-3220
  • Fax: 606-365-3166
Mailing address:
  • Phone: 606-365-3220
  • Fax: 606-365-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1544DT
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1544DT
License Number StateKY

VIII. Authorized Official

Name: JOSHUA E NICHOLS
Title or Position: OWNER
Credential: OD
Phone: 606-365-3220