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General NPI Number Information
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NPI Number | 1609017276
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Entity Type | Organization
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Legal Business Name | MADISONVILLE DISCOUNT EYEWEAR
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Dates
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Enumeration Date | 03/11/2009
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Last Update Date | 03/11/2009
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Provider Practice Location Address
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Address Line | 401 MADISON SQUARE DR STE 30
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City | MADISONVILLE
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State | KY
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Zip | 42431-2774
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Country | US
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Telephone | 270-452-2197
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Fax | 270-825-1026
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Provider Business Mailing Address
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Address Line | 401 MADISON SQUARE DR STE 30
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City | MADISONVILLE
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State | KY
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Zip | 42431-2774
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Country | US
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Telephone | 270-452-2197
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Fax | 270-825-1026
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Authorized Official
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Title or Position | OWNER / OPTICAN
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Name | MR. MEL LEN DUKES
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Credential | OPTICAN
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Telephone | 270-452-2197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1095
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License Number State | KY
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