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General NPI Number Information
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NPI Number | 1164451019
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Entity Type | Organization
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Legal Business Name | JOE C. TUCKER, O.D., P.C.S
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 12/28/2007
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Provider Practice Location Address
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Address Line | 1220 ASHLEY CIR
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City | BOWLING GREEN
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State | KY
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Zip | 42104-3338
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Country | US
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Telephone | 270-843-3904
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Fax | 270-781-4015
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Provider Business Mailing Address
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Address Line | 1220 ASHLEY CIR
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City | BOWLING GREEN
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State | KY
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Zip | 42104-3338
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Country | US
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Telephone | 270-843-4082
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Fax | 270-781-4015
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Authorized Official
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Title or Position | OWNER AND OPTOMETRIST
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Name | JOSEPH CLAY TUCKER
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Credential | O.D.
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Telephone | 270-843-4082
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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 | 940DT
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License Number State | KY
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