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General NPI Number Information
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NPI Number | 1578972113
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Entity Type | Organization
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Legal Business Name | WEST END EYE CARE, LTD.
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 2559 NEW HOLT RD
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City | PADUCAH
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State | KY
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Zip | 42001-7503
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Country | US
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Telephone | 270-558-4741
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Fax | 270-558-4742
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Provider Business Mailing Address
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Address Line | 2559 NEW HOLT RD
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City | PADUCAH
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State | KY
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Zip | 42001-7503
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Country | US
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Telephone | 270-558-4741
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CANAAN M MONTGOMERY
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Credential | OD
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Telephone | 270-558-4741
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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 | 1958DT
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License Number State | KY
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