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General NPI Number Information
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NPI Number | 1104071018
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Entity Type | Organization
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Legal Business Name | ADVANCED EYECARE ASSOCIATES, LLC
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Dates
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Enumeration Date | 11/19/2008
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Last Update Date | 11/19/2008
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Provider Practice Location Address
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Address Line | 1997 BARRETT CT
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City | HENDERSON
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State | KY
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Zip | 42420-2667
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Country | US
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Telephone | 270-826-9966
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Fax | 270-827-1206
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Provider Business Mailing Address
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Address Line | 1997 BARRETT CT
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City | HENDERSON
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State | KY
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Zip | 42420-2667
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Country | US
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Telephone | 270-826-9966
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Fax | 270-827-1206
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Authorized Official
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Title or Position | DOCTOR OF OPTOMETRY
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Name | ROBERT L COTTINGHAM
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Credential | O.D.
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Telephone | 270-826-9966
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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 | 1622DT
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License Number State | KY
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