Healthcare Provider Details

I. General information

NPI: 1326210451
Provider Name (Legal Business Name): CALVERT OPTHALMOLOGY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 CLEAR SKY COURT
CLARKSVILLE TN
37043
US

IV. Provider business mailing address

100 KEETON DRIVE
HOPKINSVILLE KY
42240-8756
US

V. Phone/Fax

Practice location:
  • Phone: 931-647-4900
  • Fax: 931-647-1333
Mailing address:
  • Phone: 270-886-2050
  • Fax: 270-886-2007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD0000035976
License Number StateTN

VIII. Authorized Official

Name: HAROLD MILTON CALVERT
Title or Position: PRESIDENT/MD
Credential:
Phone: 270-886-2050