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General NPI Number Information
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NPI Number | 1508162975
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Entity Type | Organization
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Legal Business Name | PRECISION EYECARE PLLC
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Dates
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Enumeration Date | 02/02/2011
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Last Update Date | 02/02/2011
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Provider Practice Location Address
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Address Line | 11102 HIGHWAY 44 EAST
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City | MT WASHINGTON
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State | KY
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Zip | 40047-7211
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Country | US
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Telephone | 502-904-9113
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1109
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City | MT WASHINGTON
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State | KY
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Zip | 40047-1109
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Country | US
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Telephone | 502-904-9113
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF OPTOMETRY
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Name | DR. GARY V HATHCOAT
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Credential | OD
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Telephone | 502-904-9113
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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 | 1204DT
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License Number State | KY
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