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General NPI Number Information
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NPI Number | 1568776938
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Entity Type | Organization
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Legal Business Name | CECIL & ASSOC EYECARE PLLC
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 100 WALMART DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-5548
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Country | US
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Telephone | 270-765-5218
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Fax |
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Provider Business Mailing Address
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Address Line | 100 WALMART DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-5548
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Country | US
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Telephone | 270-765-5218
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. LESLIE W CECIL
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Credential | O.D.
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Telephone | 270-765-5218
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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 | 1809DT
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License Number State | KY
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