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General NPI Number Information
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NPI Number | 1336230077
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN EYE CARE, INC.
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 2523 JACKSBORO PK
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City | JACKSBORO
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State | TN
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Zip | 37757-4847
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Country | US
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Telephone | 423-566-2020
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Fax | 423-566-4245
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Provider Business Mailing Address
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Address Line | PO BOX 306
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City | FERGUSON
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State | KY
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Zip | 42533-0306
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Country | US
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Telephone | 606-492-2211
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Fax | 606-676-0873
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Authorized Official
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Title or Position | PRESIDENT AND AUTHORIZED OFFICIAL
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Name | GARY WALTER UPCHURCH
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Credential | OD
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Telephone | 606-387-5612
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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 | TN
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