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General NPI Number Information
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NPI Number | 1245228204
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Entity Type | Organization
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Legal Business Name | EYE PHYSICIANS OF ELIZABETHTOWN PSC
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 1109 WOODLAND DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2749
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Country | US
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Telephone | 270-765-6066
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Fax | 270-737-2354
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Provider Business Mailing Address
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Address Line | 1109 WOODLAND DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2749
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Country | US
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Telephone | 270-765-6066
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Fax | 270-737-2354
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | VICKY WOODS
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Credential |
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Telephone | 270-765-6066
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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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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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