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General NPI Number Information
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NPI Number | 1427264365
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Entity Type | Organization
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Legal Business Name | THACKER AND ASSOCIATES EYE CARE
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 05/28/2010
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Provider Practice Location Address
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Address Line | 499 INDIAN MOUND DR
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City | MT STERLING
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State | KY
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Zip | 40353-1096
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Country | US
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Telephone | 859-498-8110
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Fax | 859-497-9387
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Provider Business Mailing Address
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Address Line | 499 INDIAN MOUND DR
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City | MT STERLING
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State | KY
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Zip | 40353-1096
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Country | US
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Telephone | 859-498-8110
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Fax | 859-497-9387
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMY ELIZABETH THACKER
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Credential | O.D.
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Telephone | 859-498-8110
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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 | 1605DT
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License Number State | KY
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