=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457442188
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSOCIATES IN EYE CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 03/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 207 MAIN ST
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40769-1121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-549-0464
-----------------------------------------------------
Fax | 606-549-0438
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 306
-----------------------------------------------------
City | FERGUSON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42533-0306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-492-2211
-----------------------------------------------------
Fax | 606-676-0873
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | GARY WALTER UPCHURCH
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 606-387-5612
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------