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General NPI Number Information
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NPI Number | 1043459597
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Entity Type | Organization
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Legal Business Name | EYEMART FAMILY VISION CARE INC
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Dates
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Enumeration Date | 02/06/2009
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Last Update Date | 04/04/2019
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Provider Practice Location Address
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Address Line | 100 HIGHWAY 15 S SUITE 108
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City | JACKSON
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State | KY
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Zip | 41339-8636
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Country | US
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Telephone | 606-666-4585
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Fax | 606-666-4583
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Provider Business Mailing Address
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Address Line | 9501 TAYLORSVILLE RD STE 106
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City | JEFFERSONTOWN
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State | KY
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Zip | 40299-2752
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Country | US
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Telephone | 606-666-4585
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Fax | 606-666-4583
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Authorized Official
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Title or Position | PHYSICIAN / OWNER
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Name | DR. TERRY L GOODMAN
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Credential | O.D.
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Telephone | 502-499-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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