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General NPI Number Information
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NPI Number | 1285776476
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Entity Type | Organization
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Legal Business Name | SOUTHERN KENTUCKY EYE CENTER PSC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 120 TRADEPARK DR SUITE A
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City | SOMERSET
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State | KY
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Zip | 42503-3454
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Country | US
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Telephone | 606-679-7778
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Fax | 606-451-1814
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Provider Business Mailing Address
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Address Line | 120 TRADEPARK DR SUITE A
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City | SOMERSET
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State | KY
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Zip | 42503-3454
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Country | US
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Telephone | 606-679-7778
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Fax | 606-451-1814
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Authorized Official
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Title or Position | BILLING DEPT MANAGER
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Name | TERRI COOMER
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Credential |
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Telephone | 606-679-5837
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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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