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General NPI Number Information
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NPI Number | 1386909018
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Entity Type | Organization
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Legal Business Name | E TOWN EYECARE PSC
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 103 DIECKS DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2444
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Country | US
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Telephone | 270-769-1397
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Fax | 270-765-4899
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Provider Business Mailing Address
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Address Line | 103 DIECKS DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2444
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Country | US
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Telephone | 270-769-1397
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Fax | 270-765-4899
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW KREIN
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Credential | O.D.
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Telephone | 405-747-7688
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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 | 1880DT
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License Number State | KY
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